Thursday, March 11, 2004
Subspecialist pediatric orthopaedic surgeons are faced with a growing demand to provide the majority of routine fracture care for children. This demand is based upon changing patterns of referral and "comfort level" among community orthopaedic surgeons. Many subspecialists are dismayed at the way in which this burden dilutes their ability to devote time and resources to the needs of children with complex problems within their subspecialty area of interest, the researchers report.
This problem can be resolved by developing a system that manages these patients efficiently and uses the proper mix of personnel, information technology and clinical and institutional resources, the investigators assert.
They studied a focused pediatric fracture clinic to see if it could treat large numbers of children with routine fractures efficiently while minimizing the negative effects on the primary focus of a subspecialty-specific clinical practice.
To this end, the investigators reviewed the records of the pediatric fracture clinic at Primary Children's Medical Center in Salt Lake City, Utah, for the year 2001. Data were collected on number of patients seen, type of insurance, type of fracture, referral source, number of visits per injury, percentage of clinical volume and percentage of clinical time consumed in fracture care.
During the year, the pediatric fracture clinic saw 1047 new patients. All patients were seen in a single half-day clinic, with all requests for evaluation accepted without question. An average of 87 new fractures were seen per month.
The payer mix was 68 percent indemnity insurance, 20 percent Medicaid and 12 percent self-pay. More than half of the patients were initially evaluated at outside institutions and referred to their center for evaluation. Collection rates for billed charges were 58 percent.
All patient encounters were documented using established fracture encounter templates. Laptop computers and a scribe for completion without the need for dictation or transcription were used for each encounter. All patients were entered into an electronic billing program after the clinic and the templates were completed.
A mini c-arm was used for radiographic evaluation of routine fractures, significantly improving the efficiency of patient evaluation and treatment.
The senior attending orthopaedic surgeon supervised application of all casts applied by medical assistants or residents. Resident evaluation of this experience was highly favorable in an environment where precise cast technique has become a lost art, the investigators report.
The research team was composed of John Taylor Smith, MD; Sohrab Gollogly, MD, and Nicole Clark, all of Salt Lake City.
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