321 Transfer of Care to a Clinical Nurse Specialist Pathway for Patients Undergoing Exogen Therapy Improves Outcomes, Compliance, and Refund Rate

Aim

Exogen (low-intensity pulsed ultrasound) has been shown to improve union rates following delayed/non-union. It is accompanied by a money-back guarantee in unsuccessful cases, dependent on adequate patient compliance. Using a clinician-run pathway, our unit’s results were poor, so our aim was to create a clinical nurse specialist (CNS) pathway with protocols for recording outcomes, collecting data, and claiming refunds for unsuccessful cases.

Method

This was a single-centre, retrospective, multi-cycle audit performed over 60 months on patients undergoing Exogen treatment for delayed/non-union following elective foot and ankle arthrodesis. Data was collected on union rates, Exogen compliance, and refund collections. Results were compared (Chi-squared test) for the original cohort (n = 55) and the CNS-led cohort (n = 18).

Results

In the original cohort, 24 patients (43.6%) united (mean time 225 ±145 days). Only 14 (25.5%) had treatment compliance accurately recorded and compliance rate >95%. Of 31 patients whose Exogen treatment failed, only 7 (22.6%) were eligible for a treatment cost refund due to lack of compliance / record of compliance.

In the CNS-led cohort, 12 (66.7%) patients united (mean time 190 ±77 days, p = 0.089). Sixteen patients (88.9%) had compliance accurately recorded (p<0.001), with increased compliance rates (>99%). Exogen treatment costs were refunded for 5 patients (83.3%) with residual non-union (p = 0.004).

Conclusions

Transferring patient care to a dedicated CNS-run pathway led to a non-statistically significant increase in union rates, and significantly improved compliance and fiscal return rates. Establishing dedicated protocols with paramedical staff can be cost-effective and improve outcomes, whilst reducing out-patient burden in surgical clinics.