loading page

Impact of a One-Stop Rapid Access Venous Ulcer Clinic on Inpatient Admissions
  • +4
  • Colum Keohane,
  • Momhammed Alagha,
  • Marie O'Shaughnessy,
  • Doireann Joyce,
  • Wael Tawfick,
  • Muhammad Tubassam,
  • STEWART WALSH
Colum Keohane
Galway University Hospitals
Author Profile
Momhammed Alagha
Galway University Hospitals
Author Profile
Marie O'Shaughnessy
Roscommon University Hospital
Author Profile
Doireann Joyce
Galway University Hospitals
Author Profile
Wael Tawfick
National University of Ireland Galway
Author Profile
Muhammad Tubassam
Galway University Hospitals
Author Profile
STEWART WALSH
National University of Ireland Galway
Author Profile

Abstract

Abstract Objective To determine whether the introduction of a one-stop see and treat clinic offering early reflux ablation for Venous Leg Ulcer (VLU) patients in July 2016 has affected rates of unplanned inpatient admissions due to venous ulceration. Design Review of inpatient admission data and analysis of related costs. Materials The Hospital Inpatient Enquiry collects data from acute public hospitals in Ireland on admissions and discharges, coded by diagnosis and acuity. This was the primary source of all data relating to admissions and length of stay. Costs were calculated from data published by the Health Service Executive in Ireland on average costs per inpatient stay for given diagnosis codes. Methods Data were collected on admission rates, length of stay, overall bed day usage, and costs across a four-year period; the two years since the introduction of the rapid access clinic, and the two years immediately prior as a control. Results 218 patients admitted with VLUs accounted for a total of 2,529 inpatient bed-days, with 4.5(2-6) unplanned admissions, and a median hospital stay of 7(4-13) days per month. Median unplanned admissions per month decreased from 6(2.5-8.5) in the control period, to 3.5(2-5) after introduction of the clinic p=.040. Bed-day usage was significantly reduced from median 62.5(27-92.5), to 36.5(21-44) bed-days per month (p=.035), though length of stay remained unchanged (p=.57). Cost of unplanned inpatient admissions fell from median \euro33,336.25(\euro14,401.26-\euro49,337.65) per month to \euro19,468.37(\euro11,200.98-\euro22,401.96) (p=.03). Conclusions Admissions for inpatient management of VLUs have fallen after beginning aggressive endovenous treatment of venous reflux in a dedicated one-stop see-and-treat clinic for these patients. As a result, bed-day usage has also fallen, leading to cost savings.

Peer review status:Published

Aug 2020Published in European Journal of Vascular and Endovascular Surgery volume 60 issue 2 on pages e55. 10.1016/j.ejvs.2020.03.023