scholarly journals Optimizing the Patient Telemedicine Experience in an Orthopaedic Clinic

Cureus ◽  
2021 ◽  
Author(s):  
Margaret A Sinkler ◽  
Joshua D Dolan ◽  
Michael J Steflik ◽  
Peter Harimtepathip, MD ◽  
J. Shell Cox ◽  
...  
Keyword(s):  
Orthopaedic Clinic

Diagnosis and management of chronic hip and knee pain in a Tasmanian orthopaedic clinic: a study assessing the diagnostic and treatment planning decisions of an advanced scope physiotherapist

2019 ◽  
Vol 25 (1) ◽  
pp. 60 ◽  
Author(s):  
Dave Jovic ◽  
Jonathan Mulford ◽  
Kathryn Ogden ◽  
Nadia Zalucki
Keyword(s):  
Knee Pain ◽  
Conversion Rate ◽  
Clinical Effectiveness ◽  
Weighted Kappa ◽  
Orthopaedic Surgeon ◽  
Advanced Practice ◽  
Model Of Care ◽  
Orthopaedic Clinic ◽  
Orthopaedic Care ◽  
Planning Decisions

The aim of this study is to investigate the clinical effectiveness of an advanced practice physiotherapist triaging patients referred from primary care to the orthopaedic clinic with chronic hip and knee pain. An exploratory study design was used to assess 87 consecutive patients referred from general practice in Northern Tasmania. Patients were assessed by both an advanced practice physiotherapist and a consultant orthopaedic surgeon. Diagnostic and treatment decisions were compared, with the orthopaedic consultant decision defined as the gold standard. By using these decisions, over and under referral rates to orthopaedics could be calculated, as well as the surgical conversion rate. Conservative care of patients referred to the orthopaedic clinic with hip and knee pain was limited. The diagnostic agreement between the advanced scope physiotherapist and the orthopaedic surgeon was almost perfect (weighted kappa 0.93 (95% CI 0.87–1.00)), with treatment agreement substantial (weighted kappa 0.75 (95% CI 0.62–0.89)). Under a physiotherapist-led triage service, the surgical conversion rate doubled from 38% to 78%. An advanced physiotherapist assessing and treating patients with chronic hip and knee pain made decisions that match substantially with decisions made by an orthopaedic consultant. A model of care utilising an advanced physiotherapist in this way has the potential to support high-quality orthopaedic care in regional centres.

scholarly journals Initial Evaluation by a Nonoperative Provider Does Not Delay the Surgical Care of Operative Ankle Fractures in a Walk-in Orthopaedic Clinic

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0017
Author(s):  
Matthew N Fournier ◽  
Joseph T Cline ◽  
Adam Seal ◽  
Richard A Smith ◽  
Clayton C Bettin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ankle Fracture ◽  
Initial Evaluation ◽  
Orthopaedic Surgeon ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Foot And Ankle ◽  
Orthopaedic Clinic ◽  
Orthopaedic Surgeons ◽  
Clinic Visits

Category: Ankle, Trauma Introduction/Purpose: Walk-in and “afterhours” clinics are a common setting in which patients may seek care for musculoskeletal complaints. These clinics may be staffed by orthopaedic surgeons, nonsurgical physicians, advanced practice nurses, or physician assistants. If orthopaedic surgeons are more efficient than nonoperative providers at facilitating the care of operative injuries in this setting is unknown. This study assesses whether evaluation by a nonoperative provider delays the care of patients with operative ankle fractures compared to those seen by an orthopaedic surgeon in an orthopaedic walk-in clinic. Methods: Following IRB approval, a cohort of patients who were seen in a walk-in setting and who subsequently underwent surgical treatment for an isolated ankle fracture were retrospectively identified. The cohort was divided based on whether the initial clinic visit had been conducted by an operative or nonoperative provider. A second cohort of patients who were evaluated and subsequently treated by a fellowship-trained foot and ankle surgeon in their private practice was used as a control group. Outcome measures included total number of clinic visits before surgery, total number of providers seen, days until evaluation by treating surgeon, and days until definitive surgical management. Results: 138 patients were seen in a walk-in setting and subsequently underwent fixation of an ankle fracture. 61 were seen by an orthopaedic surgeon, and 77 were seen by a nonoperative provider. No significant differences were found between the operative and nonoperative groups when comparing days to evaluation by treating surgeon (4.1 vs 4.5, p=.31), or days until definitive surgical treatment (8.4 vs 8.8, p=.58). 62 patients who were seen and treated solely in a single surgeon’s practice had significantly fewer clinic visits (1.11 vs 2.03 and 2.09, p<.05), as well as days between evaluation and surgery compared to the walk-in groups (5.44 vs 8.44 and 8.78, p<.05). Conclusion: Initial evaluation in a walk-in orthopaedic clinic setting is associated with a longer duration between initial evaluation and treatment compared to a conventional foot and ankle surgeon’s clinic, but this difference may not be clinically significant. Evaluation by a nonoperative provider is not associated with an increased duration to definitive treatment compared to an operative provider.

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