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The economics of appliance—a study of appliance loan in accident and emergency departments
  1. Chikezie Dean Okereke1,
  2. Melanie Kavanagh2,
  3. John Sloan3
  1. 1Department of Accident and Emergency Medicine, Saint James's University Hospital, Leeds
  2. 2Department of Accident and Emergency Medicine, The General Infirmary at Leeds
  3. 3Department of Accident and Emergency Medicine, The General Infirmary at Leeds
  1. Correspondence to: Mr Chikezie Dean Okereke, 34 Long Causeway, Adel, Leeds LS16 8EQ, UK (chikezieo{at}

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Editor,—It is common experience for all staff who work in accident and emergency (A&E) that appliances such as crutches, walking sticks, knee splints and frames can be in short supply. One of the results of this is that patients can be denied appliances out of hours. Also loss of these appliances may lead to increasing hospital costs. Emerg Med J 2001;18:523

With this in mind, we sent a questionnaire to all A&E departments in England and Wales asking if they had procedures in place to manage the purchase, loan and recovery of appliances. We also sought to determine the estimated costs to the departments.

There was a 56% response rate and 90% of the respondents loaned appliances to the population they served. Only 43% of the respondents kept an inventory (usually book records), of which, only 58% followed up the patients who did not return the loaned appliances. Some 63% of the respondents agree there is need for a tracking system.

This survey shows that A&E departments have very little monitoring of appliances loaned. Wider information about the problem is scarce. The department of health had no strategy or view on the matter. In the United States, health care institutions commonly pool their interests and form group purchasing organisations to reduce costs and provide better equipment management.1,2 We also know that supermarkets have had to act as a result of the constant loss of trolleys.

We estimate that a busy department that loses five elbow crutches a day at a cost of £10 per crutch will lose £50 per day and £18 250 per annum. A&E computer systems should have the facility to track appliances. Bar codes and automatically generated letters will further simplify this. A combination of this and a mandatory small deposit may be required as the basis for a managed system.


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