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Decreasing Unexpected Returns to Orthopedic Hand Clinic: Improving Efficiency of Health Care Delivery
Kevin J Little1,2, Samir Trehan1,3, Roger Cornwall1,2
1Department of Surgery, Division of Pediatric Orthopaedics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Unexpected return to clinic (URTC) visits were reduced by 62% through improved patient education and cast management. This quality improvement initiative saved over $420 per avoided visit, benefiting patients and the healthcare system.
Area of Science:
- Pediatric healthcare quality improvement
- Patient safety and outcomes
- Healthcare cost reduction strategies
Background:
- Unexpected return to clinic (URTC) visits impose significant financial burdens on families and strain healthcare resources.
- A baseline URTC rate of 1.8 per 100 follow-up visits was identified at a tertiary care pediatric hospital.
Purpose of the Study:
- To decrease the rate of URTC visits by 50% using quality improvement methodology.
- To identify common causes of URTC visits and implement targeted interventions.
Main Methods:
- A weekly P-chart monitored URTC visit rates from February 2014 to May 2015.
- Pareto charts identified cast issues, new symptoms, and worsening symptoms as primary drivers of URTC visits.
- Plan-Do-Study-Act cycles informed interventions focused on standardized patient education and cast management.
Main Results:
- URTC rates decreased by 62%, from 1.8 to 0.7 per 100 follow-up visits.
- Cast issues were the most frequent cause (50.5%), followed by new symptoms (29.5%).
- Each avoided URTC visit resulted in average savings of $350.38 in medical charges and $70 in non-medical costs for families.
Conclusions:
- Implementing quality improvement strategies, including standardized patient education and optimized cast usage, significantly reduced URTC visits.
- These improvements led to substantial cost savings, exceeding $420 per avoided visit, encompassing both medical and non-medical expenses.
- The study demonstrates the effectiveness of targeted interventions in enhancing patient care and healthcare system efficiency.
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.
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