Decreasing Unexpected Returns to Orthopedic Hand Clinic: Improving Efficiency of Health Care Delivery

Abstract

Purpose:An unexpected return to clinic (URTC) visit can place a substantial financial burden on patients and families while stressing the health care system. Our SMART aim was to decrease the rate of URTC visits from 1.8 per 100 patient follow-up visits by 50% using quality improvement methodology.Methods:The rate of URTC visits was tracked at our tertiary care pediatric hospital from February 1, 2014, to May 31, 2015, using a weekly P-chart. Interventions were studied from January 1 to May 31, 2015. Pareto charts determined the common causes of URTC visits. Interventions were studied using Plan-Do-Study-Act cycles. Medical charges for URTC patient visits were collected and patients/families were given a cost survey to determine nonmedical costs associated with the clinic visits.Results:Cast issues (50.5%) were most common, followed by new symptom/complaints (29.5%), and persistent or worse symptoms (15.2%). Following interventions, URTC rates decreased from 1.8 to 0.7 (⇓62%) per 100 follow-up visits during the study period. Interventions were targeted toward cast use and improved patient education via standardized materials. The average URTC resulted in $350.38 of charges. Additionally, the average URTC cost families $70 for a half day of lost wages and travel expenses.Discussion:Applying quality improvement methodology to URTC visits by standardizing patient education and minimizing cast usage resulted in a substantial decrease in the number of patients returning to clinic, both for scheduled follow-ups and unexpectedly. This improvement resulted in a savings of more than $420 per visit saved, including medical and nonmedical costs.

Osteoarthritis Increases the Frequency and Duration of Postoperative Hand Clinic Visits after Carpal Tunnel Release

“…24 A study in 2018 found that the average patient cost of an unexpected visit to return to hand clinic was $350 of medical charges and $70 of nonmedical, out-of-pocket costs for lost work and travel. 25 This study is not without limitations. Given its retrospective nature, it was difficult to capture all symptoms patients were experiencing during follow-up visits.…”

“… 24 A study in 2018 found that the average patient cost of an unexpected visit to return to hand clinic was $350 of medical charges and $70 of nonmedical, out-of-pocket costs for lost work and travel. 25 …”

The Role of Patient and Parent Education in Pediatric Cast Complications

“…Several researchers have examined the role of cast care education in the incidence of cast complications. Little et al (2018) and Newman and Gaffney (2018) both examined the effect of standardized cast care education on the rate of unplanned RTC. Both studies noted a decrease in unplanned RTC with the combination of verbal and written cast care instructions.…”

“…Standardized patient and family education, adequate telephone triage, and appropriate follow-up can prevent such visits and decrease unnecessary expenses both on the patient and institutional ends (DiPaola et al, 2014; Doan et al, 2019; Jackson et al, 2018; Rogers & Attia, 2017; Sawyer et al, 2010). There is sufficient evidence to support an innovation that addresses varying learning styles; several studies demonstrate success with multimodal approaches, which include verbal, written, and video instructions (Ismail et al, 2016; Little et al, 2018; Newman & Gaffney, 2018).…”