A Multidisciplinary Hand Clinic Using Physiatrists for the Evaluation of Non-Operative Pathologies

Healthcare systems often face challenges in managing wait times for urgent surgical cases. Prior research has shown that surgical waitlists can be influenced by triage models and specialty involvement. However, the role of physiatrists in hand clinics remains underexplored. No prior work had resolved how integrating non-operative specialists affects surgical referral volumes. This gap motivated the investigation into multidisciplinary triage systems. It was already known that plastic surgeons handle most hand clinic referrals. Yet, the impact of adding physiatry to the model had not been quantified. This study aimed to address that uncertainty by analyzing clinic data before and after model implementation. The focus was on how triage distribution changes with multidisciplinary involvement.

The study aimed to evaluate the effects of a multidisciplinary hand clinic model on plastic surgery waitlists and referral volumes. Specifically, the researchers sought to determine if adding physiatrists could reduce the burden on plastic surgeons. The problem addressed was the inefficiency of traditional triage systems in handling non-operative cases. The motivation stemmed from the need to optimize clinic resources and improve urgent case access. By introducing physiatry into the model, the team hypothesized that non-operative patients could be managed more efficiently. This approach could potentially free up plastic surgeons to focus on urgent surgical cases. The study's design was retrospective, comparing data from six months before and after the model change. The primary goal was to assess whether the new model improved triage efficiency and reduced wait times.

The researchers conducted a retrospective data analysis of new referrals to a hand clinic in Calgary. They collected data from six months before and after the introduction of a multidisciplinary model. The data included patient demographics, wait times, triage types, and referral volumes. The clinic database was used to track how referrals were distributed among different disciplines. Before the model change, the majority of referrals were directed to plastic surgery. After introducing physiatry, the team monitored shifts in referral patterns. They compared the proportion of urgent operative referrals and mean wait times before and after the change. Statistical analysis was used to assess the significance of the observed changes. The study design allowed for a direct comparison of triage efficiency under two different models.

Following the introduction of physiatry, the proportion of referrals to plastic surgery decreased from 81% to 62%. Referrals to physiatry increased from 0% to 24%. The volume of urgent operative referrals triaged to plastic surgery rose by 7%, from 67% to 74%. Mean wait times for urgent plastic surgery referrals decreased by 1.7 months, though the change was not statistically significant (P = 0.09). The total number of new referrals remained stable, with 728 before and 730 after the model change. Physiotherapy referrals dropped from 4% to 2%, while minor surgery referrals remained at 6%. These results suggest that the multidisciplinary model may improve triage efficiency. The data indicate that non-operative cases can be redirected to physiatry and physiotherapy, reducing the plastic surgery workload.

The authors propose that integrating physiatrists into a hand clinic can improve triage efficiency and reduce plastic surgery waitlists. The findings suggest that non-operative cases may be better managed by physiatry, allowing plastic surgeons to focus on urgent surgical referrals. The observed 7% increase in urgent referrals to plastic surgery supports this model's effectiveness. However, the decrease in wait times did not reach statistical significance. The study's results are limited to the observed period and clinic setting. The authors do not claim that this model is essential for all hand clinics. They emphasize that the multidisciplinary approach may be a viable solution for clinics facing similar challenges. The implications are specific to the observed outcomes and do not extend to broader healthcare systems.