Efficiency Benefits of Live Fluoroscopy in Hand Clinics

Postoperative imaging protocols for common hand procedures typically consist of 2-3 plain radiographs at defined intervals dependent on the surgery. Radiographs typically verify reduction, hardware position, and/or evaluate for complications, but also generate costs and alterations in clinic flow. We hypothesize the use of mini-fluoroscopic images will provide comparable clinical data with less cost and improved clinic flow. The objectives of the study were to determine if clinic-based fluoroscopic imaging is feasible for post-operative hand patients and if fluoroscopic imaging results in improved clinic flow (less waiting and more time with provider) and theoretical cost savings using mini-fluoroscopy instead of traditional radiographs.

With institutional review board exemption, the prospective use of mini-fluoroscopic evaluation of post-operative hand surgery patients was compared to traditional radiographs using time-based cohort analysis. Patients who underwent percutaneous pinning of phalanges/metacarpals, ORIF (open reduction and internal fixation) of phalanges/metacarpals or ORIF of distal radius fractures were included to evaluate common hand surgery patients. Each cohort consisted of a 3-month data collection period with prospective measures of clinic flow (wait times, appointment times, time with provider) and estimated cost compared between the groups.

24 patients met inclusion criteria for data analysis; 11 patients in the mini-fluoroscopy group and 13 patients in the traditional radiograph group. Appointments using mini-fluoroscopy were 24 minutes shorter (53 vs 77 minutes) from patient check-in to check out time. Check-in time to rooming was 10 minutes quicker (9 vs. 19 minutes) using mini-fluoroscopy. Traditional hand radiographs have a face-value of $734 per appointment/series for a total theoretical savings of $9540 (n=13).

The use of mini-fluoroscopy during orthopedic hand surgery post-operative visits provides a feasible, quick, cost effective way to evaluate patients postoperatively, ultimately, resulting in quicker patient appointments and greater time spent with providers. Level of Evidence: III.