[AVBC 2025] Implementing a New Care Model for selected Ankle and Foot Fracture (sAFF) at TTSH ED
Care Process & Redesign
Appropriate & Value-based Care Conference
National Healthcare Group
11 December 2025
To evaluate the effectiveness of a new care model against standard care for sAFF management in TTSH. This new care model improves early patient function without compromising fracture healing, while reducing immobilization-related risks.
Year Submitted: 2025
Published Date: 11 December 2025
Tags: Care Process ＆ Redesign, Workflow Redesign, Quality Improvement, Functional Outcome, Productivity, Cost Saving, Time Saving, Value Based Care, Patient Reported Outcome Measures, Safe Care
About this Content
Aims
To evaluate the effectiveness of a new care model against standard care for sAFF management in TTSH.
Background
These typically non-surgical, ambulatory injuries are currently managed with a plaster cast for two weeks of non-weight-bearing (NWB) immobilization before orthopaedic follow-up. However, prolonged NWB can impair function, increase caregiver dependence, elevate fall risk, and lead to deconditioning and skin complications. To address these challenges, three departments are collaborating to implement this novel care model.
Methods
This care model, grounded in risk-based assessment, clinical evidence, and expert consensus, was implemented for eligible patients presenting to the TTSH Emergency Department. The intervention group received a removable walker boot (RWB) with weight-bearing as tolerated (WBAT), supported by Advanced Practice Physiotherapist (APP)-led care, including targeted education and exercises. In contrast, the control group received standard care with plaster casting and non-weight-bearing (NWB). APP review at week 2 replaced orthopaedic follow-up, potentially freeing specialist resources. Retrospective data analysis assessed functional fracture recoverydefined by pain-free ambulationalongside pain scores, Patient-Specific Functional Scale (PSFS) outcomes at weeks 2 and 12, sick leave utilization, and cost efficiency.
Results
From April 2024 to March 2025, 171 patients were recruited, all completing 2-week follow-up and 95 completing 12-week follow-up. At week 2, the intervention group showed significantly better functional fracture healing, with comparable outcomes at week 12. They also reported consistently higher PSFS scores and lower pain levels at both timepoints. The model reduced sick leave by an average of 29 days for working adults and saved approximately $305.10 per patient. No adverse events occurred in the intervention group, compared to three in the control group.
Conclusion
This new care model improves early patient function without compromising fracture healing, while reducing immobilization-related risks. It offers greater cost-effectiveness, enhances productivity, and holds strong potential for adoption across other public healthcare institutions.
Lessons Learnt
The implementation of a new care model can significantly improve patient outcomes and reduce healthcare costs. Collaboration across departments is crucial for successful implementation.
Keywords
Care Model, Ankle Fracture, Foot Fracture, Emergency Department, TTSH, Cost-effectiveness, Productivity
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Tan Tock Seng Hospital |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Orthopaedics, Emergency Medicine |
Project Lead(s) | Loh Wei Bing |
Project Member(s) | Loh Wei Bing |
Connect with this contributor!
Loh Wei Bing - wei.bing.loh@nhghealth.com.sg