Orthoplastics, tariffs and the reality of providing complex fracture care

The United Kingdom (UK) Major Trauma Network has encouraged cohorting of significantly injured patients with specific injury patterns. Complex injuries to the limbs is a key area of this patient population. Funding and clinician resource allocation, have not been appropriately adjusted to take account of this approach. We assessed the orthoplastic trauma workload in our unit over a 12 month period, taking into account the resource burden of each admission in comparison to the funding received.

The details of admissions requiring orthoplastic care over the period from February 2017-February 2018 were extracted from hospital records. Data regarding patient demographics, admission length, procedures and complications was analysed. Additional data regarding time spent in theatre was obtained from computerised records, as well as detailed coding data regarding clinical events coded for and funding received for the admission.

24 patients were identified as meeting the criteria for inclusion in this study. Mean length of stay was 23 days (1-98 days) and theatre time 386 min (15-842 min). Average payment per admission was £14,497 (£593-£86,245).

Tariff payments barely cover the cost of a hospital bed and theatre time. Materials costs, as well as the additional costs associated with providing a high quality specialist service mean that our orthoplastic service is currently being run at a significant loss. The benefits for patients in having a well-established orthoplastic unit are numerous and well documented. This study provides evidence to support negotiation for a tariff uplift to allow ongoing provision of a high quality orthoplastic service without detriment to hospital budgets.