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Counting health care: is there aF in CE?
1Department of Orthopaedic & Trauma Surgery, Hull Royal Infirmary, Kingston-upon-Hull, HU3 2LZ, UK.
Summary
The finished consultant episode metric is not ideal for measuring orthopedic surgery care delivery. Many patients within the system use operating time, but aren't counted as new referrals, skewing results.
Area of Science:
- Health economics
- Orthopedic surgery
- Healthcare delivery metrics
Background:
- The finished consultant episode (FCE) is a common metric used by health economists to assess healthcare delivery.
- Its applicability in specialized surgical fields like orthopedics has not been thoroughly evaluated.
Purpose of the Study:
- To evaluate the appropriateness of the FCE as a measure of healthcare delivery in elective orthopedic surgery.
- To analyze how patient referrals and operating time are allocated within the orthopedic surgery system.
Main Methods:
- Retrospective review of clinical notes for 174 consecutive patients undergoing elective orthopedic procedures.
- Analysis of patient referral sources (general practitioner vs. internal system) and operating time allocation.
Main Results:
- 51% of patients were referred by general practitioners, but these accounted for only 47% of operating time.
- A significant portion of operating time was used by patients already within the hospital system, who are not classified as new consultant referrals under standard NHS accounting.
- This leads to an undercounting of care episodes for a substantial number of patients.
Conclusions:
- The FCE metric is an inappropriate measure for assessing healthcare delivery in orthopedic surgery.
- Current accounting practices may not accurately reflect the full scope of care provided in specialized surgical departments.
- Re-evaluation of healthcare delivery metrics is needed for surgical specialties.