The acute foot and ankle soft tissue clinic (FAST) is an advanced practice physiotherapist (APP) led clinic within the fracture clinic at Mid Yorkshire Hospitals NHS Trust. The APP will independently assess, diagnose, request diagnostic imaging and blood markers, prescribe where appropriate and manage injuries such as Achilles tendon (TA) ruptures which would previously be seen by Consultants. The aim of this evaluation was to assess safety and cost effectiveness of the APP led FAST clinic.
An audit evaluation of of the Fast clinic
Results: Data for 173 new patients was reviewed from February 2019 to February 2020. Injury type and prevalence: high grade ankle ligament injuries 51, low-moderate grade ankle ligament injuries 25, Chronic ankle instability 4, Syndesmosis injury 2, Acute TA ruptures 41, Neglected TA ruptures 5, Partial TA ruptures 4, Other calf injury 5, Achilles tendonitis 6, Bony injury 13, Crush/ contusion injury 9, Soft tissue injury foot 8. Outcome: 96 % of patients managed conservatively. Non-medical referrer imaging requests: MRI 28, CT 2, ultrasound 7. 41 independent non-medical prescriber prescriptions issued for venous thromboembolism prophylaxis with no documented medication side effects or adverse reactions. 2 incidents of DVT ( one at 12 weeks). 2 Achilles tendon re-ruptures (one at six months). Cost evaluation: Estimated fifty percent cost saving for APP clinic versus Consultant clinic.
Conclusion(s): This evaluation demonstrates that APPs are safe and cost effective in managing complex acute soft tissue injuries of the foot and ankle within the fracture clinic. The vast majority of injuries were conservatively managed successfully with low re-rupture and surgical repair rates. Independent non-medical prescribing of VTE prophylaxis management was safe with low VTE rates.
Cost and savings
This clinic realised a fifty percent cost saving for an APP clinic versus a Consultant clinic
This evaluation has supported the development of a further APP led soft tissue clinic being developed within the fracture clinic. Succession planning for trainee APPs has been initiated in the Trust to support clinics moving forward. Protected Achilles tendon rupture clinic slots introduced to maintain capacity for this high risk group.
Top three learning points
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