Referral patterns to a pediatric orthopedic clinic: pediatric orthopedic surgeons are primary care musculoskeletal medicine physicians

Abstract

In 2004, Reeder and in 2012, Schwend reported that inappropriate nonsurgical referrals to pediatric orthopedic clinics create a misuse of resources. Additional authors have called for re-emphasis and additional training in musculoskeletal medicine for primary care physicians (PCP) to improve the confidence, knowledge and performance when managing musculoskeletal conditions. The current study compares the diagnoses referred to a pediatric orthopedic clinic with diagnoses recommended for referral by the American Academy of Pediatrics (AAP) guidelines to determine if any improvement in the quality of referrals has occurred since Reeder and Schwend’s article. A chart review of new referrals to a pediatric orthopedic clinic during a 3-month-period was performed. Data were collected on age, sex, referring diagnosis, referral source, final diagnosis and treatment. In total 230 new consults were evaluated. The referral source was a PCP in 169 (73.5%) cases, 30 (13%) self-referrals by a parent, 19 (8.3%) from another orthopedic surgeon, 9 (3.9%) from a neurologist and 3 (1.3%) from another specialist. Fifty percent of referrals met the criteria outlined in the AAP guidelines for referral to a pediatric orthopedic specialist and 48% were classified as primary care musculoskeletal conditions. During the 15 years since the publication of Reeder’s study and despite a limited re-emphasis on musculoskeletal education, the percent of inappropriate referrals to a pediatric orthopedic clinic remains unchanged at 50%. We support an expanded musculoskeletal educational effort aimed at the medical, resident and pediatrician level, online decision-making aids, and implementation of a standardized referral form with the specific criteria of the AAP included.

Inter-physician Communication in Pediatric Orthopaedics: What do Pediatricians Want to Hear From us?

“…Prior studies have focused on referral patterns to the pediatric orthopaedic clinic, noting nearly half of referrals did not require elevation to the specialist level based on American Academy of Pediatrics guidelines. [1][2][3][4] Inappropriate referrals can lead to increased health care costs for patients. 3 In addition, due to the unequal distribution of pediatric orthopaedic surgeons, 5,6 certain practices in regions with limited pediatric orthopaedic resources may become saturated with referrals for primary care musculoskeletal problems.…”

“…[1][2][3][4] Inappropriate referrals can lead to increased health care costs for patients. 3 In addition, due to the unequal distribution of pediatric orthopaedic surgeons, 5,6 certain practices in regions with limited pediatric orthopaedic resources may become saturated with referrals for primary care musculoskeletal problems. To improve the quality of referrals, solutions offered range from expanding musculoskeletal education in the form of continuing medical education or boot camp-style courses to creating online decision-making aids with specific AAP referral criteria included.…”

“…To improve the quality of referrals, solutions offered range from expanding musculoskeletal education in the form of continuing medical education or boot camp-style courses to creating online decision-making aids with specific AAP referral criteria included. 3 Although there has been a movement towards educating general pediatric providers on improving referrals to the orthopaedic clinic, minimal investigation has been performed on how pediatric orthopaedic surgeons can better communicate with their general pediatric colleagues, which could simultaneously improve the quality of referrals to orthopaedic clinic and improve patient outcomes. In our study, we evaluate how general pediatric providers in our region perceive their current communication with pediatric orthopaedic surgeons to determine the need for improvements in interprofessional communication.…”

“…In pediatric orthopaedics, communication with referring general pediatric providers is important not only for patient care, but also to maintain relationships and build a practice. Prior studies have focused on referral patterns to the pediatric orthopaedic clinic, noting nearly half of referrals did not require elevation to the specialist level based on American Academy of Pediatrics guidelines 1–4 . Inappropriate referrals can lead to increased health care costs for patients 3 .…”

“…In addition, due to the unequal distribution of pediatric orthopaedic surgeons, 5,6 certain practices in regions with limited pediatric orthopaedic resources may become saturated with referrals for primary care musculoskeletal problems. To improve the quality of referrals, solutions offered range from expanding musculoskeletal education in the form of continuing medical education or boot camp-style courses to creating online decision-making aids with specific AAP referral criteria included 3 . Although there has been a movement towards educating general pediatric providers on improving referrals to the orthopaedic clinic, minimal investigation has been performed on how pediatric orthopaedic surgeons can better communicate with their general pediatric colleagues, which could simultaneously improve the quality of referrals to orthopaedic clinic and improve patient outcomes.…”