ORTHOPAEDIC TRIAGE: COST EFFECTIVENESS, DIAGNOSTIC/SURGICAL AND MANAGEMENT RATES

Appendix 1 – Full breakdown of Cost Analysis

Costs ESP – 8a wage – calculate 52 weeks (including annual leave, paternity leave, meetings etc). Top increment 8a 11 hours a week – 8a wages 11 hours a week including on costs - £29.45 an hour £29.45 X 11 X 52 = £16,845.4 Band 3 Admin costs 3 hours a week including on costs -£11.30 an hour £11.30 X 3 x 52 = £1762.8 Cost per year £16,845.4 + £1762.8 = £18608.2

Number of New patients seen in TOMS (including non attendances) 273 (546 ½ hour slots) = £58.70 per new assessment Number of follow ups 88 = £29.35 per follow up 634 ½ hour slots= £29.35 per ½ hour slot

Cost Analysis Cost Saving – (1) Paper Triage – Orthotics Number of patients referred to Orthotics – 51 Complete Cost Saving. These patients previously would have seen Orthopaedic surgeons. - £150 per new assessment 51 X £150 = £7650 (2) ESP Triage – Discharge first appointment

Number of patients seen and discharged – 184 (Discharge 49, physio seen and discharged 39 (5 referred back to ESP for review), bio 16 , Orthotics 6 , DNA/Canc 36 , Various Primary Care 33, Neurology 1, Pain Clinic 2, Rheumatology 1, Paeds physio 1 ) Cost per appointment – £58.70 X 184 = £10800.8 Cost per Consultant Appointment in Comparison (£150 each) - 184 x £150 = £27, 600 Cost Saving - £27, 600 - £10800.8

=

£16,799.2

(3) Patients have MRI scan and discharge Number of Patients – 13 Initial ax = £58.70 + follow up app £29.35 x 13 = £1144.65 Compared to Ortho Initial ax = £150 + follow up app £ 80 x 13 = £2990 Cost Saving = £2990 – £1144.65 = £1,845.35

(4) Patients have MRI scan and then inject (2 appointments)

Number of Patients – 2 Initial ax = £58.70 + 3 follow ups @ £29.35 each x 2= £293.50 Compared to Ortho Initial ax = £150 + 2 follow ups @ £80 each x 2= £620 Cost Saving = £326.50

(5) Patients have X-ray and then discharge Number of Patients = 12 Initial ax = £58.70

+ follow up £29.35 X 12

= £1056.60

Compared to Ortho Initial ax - £150 x 12 = £1800 Cost Saving £1800 - £1121.22 = £743.4 (6) Patients referred for Injection and discharged Number of Patients = 9 Initial ax = £58.70 + 2 follow ups @ £29.35 each x 9 = £1056.6

Compared to Ortho Initial ax = £150 + 1 follow up £80 x 9 = £2070 Cost saving = £2070 – £1123.38 = £1,013.40

Additional Costs (1) Patients referred to T & O initial assessment Number = 8 Cost – 8 X £58.70

= £469.6

This is an extra cost as these patients would have not been seen in Triage (2) Patients have MRI scan and referred to T & O

Number of Patients = 12 Initial ax = £58.70 + follow up app £29.35 + Ortho new Ax £150.00 x 12 = £2856.6 Compared to Ortho Initial ax = £150 + follow up app £80 x 12 = £2760 Cost = £2856.6 – £2760 = £96.60 (3) Patients have x-ray and referred to T & O Number of Patients = 15 Initial ax - £58.70 + follow up app £29.35 + Ortho new Ax £150 = £238.05 x 15 = £3570.75 Compared to Ortho Initial ax £150 x 15 = £2250 Cost = £3570.75 – £2250 = £1,320.75

(4) Patients referred for injection, and then referred to T & O Number of Patients = 3 Initial ax = £58.70 + 2 follow ups @ £29.35 each + Ortho new ax £150 x 3 = £802.20 Compared to Ortho

Initial ax £150 + 1 follow up £80 x 3 = £690 Cost = £112.20 Overall additional costs = £469.60 + £96.60 + £112.20 + £1320.75 = £1999.15

Cost Analysis Additional costs from Triage Wages = £18608.2 Additional Costs = £1999.15 Total = £20,607.35 Cost Savings from Triage Savings = £7650 + £16,799.2+ £1845.35 + £326.50+ £743.40 + £1013.40 Overall savings = £28,377.85 Overall Cost Benefit £28377.85 - £20607.35 = £7770.50