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.