RESUMEN
BACKGROUND CONTEXT: In an effort to efficiently deliver high-value spine surgical care, spine surgery clinics may triage new patient referrals. A triage system with attending surgeon review of referred patient images may improve the surgical conversion rate (SCR) of a spine surgical clinic, and shift the distribution of new patients in clinic toward those most likely to derive benefit from surgery. PURPOSE: To quantify SCR and number of triage steps by referral source in a tertiary referral spine clinic where all referrals are triaged by attending surgeons. DESIGN: All spine surgery clinic patients seen for a new patient visit (NPV) at an academic medical center over a one-year period had their triage process and outcome (surgery or no surgery) reviewed. PATIENT SAMPLE: The 1398 new adult patients seen for elective spine pathology were queried. OUTCOME MEASURES: SCR was defined as the percentage of new patients who underwent elective spine surgery within 18 months of NPV. Triage steps were defined as an action item by triage staff (ie, obtaining patient records) or by the patient (ie, undergoing additional imaging). METHODS: All new patient visits were evaluated for referral source, number of triage steps, and triage outcome. Time from referral to NPV, and time from NPV to surgery were also recorded. SCR, triage steps, and time-intervals were calculated for each surgeon and referral source and compared. Statistical analysis of variance (ANOVA) was used to ascertain differences. RESULTS: The overall SCR for the 4-surgeon group was 41.6%. This ranged among the surgeons from 24.7% to 60.1%. The referral sources with the highest SCR were in-system spine advanced practice providers (APPs) and in-system physical medicine and rehabilitation providers. Spine APPs also demonstrated the smoothest referral process, requiring the fewest steps. CONCLUSIONS: Our findings provide a framework for assessment of triage processes at other institutions, as well as the impact of upgrades to our triage process as we work to improve triage efficiency. In the present study, referrals from providers familiar with spine pathology resulted in the highest SCR and fewest triage steps.
Asunto(s)
Derivación y Consulta , Triaje , Humanos , Derivación y Consulta/estadística & datos numéricos , Adulto , Columna Vertebral/cirugía , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Cirujanos/estadística & datos numéricos , Masculino , FemeninoRESUMEN
SUMMARY: Open segmental tibial fractures are difficult injuries fraught with potential for complications. Delays or missteps in treatment and soft tissue coverage can lead to disastrous outcomes. This article and the accompanying video demonstrate an example of a timely, team-based approach for management of an open segmental tibial shaft fracture with complex osseous fixation and soft tissue reconstruction.
Asunto(s)
Fracturas Abiertas , Procedimientos Ortopédicos , Fracturas de la Tibia , Fracturas Abiertas/diagnóstico por imagen , Fracturas Abiertas/cirugía , Humanos , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Resultado del TratamientoRESUMEN
Initially developed to reduce intramedullary pressures during long bone intramedullary nail placement, the reamer-irrigator-aspirator (RIA) can be used to harvest large volume autologous bone graft from the intramedullary canal of a long bone. This case-based surgical technique video demonstrates the appropriate techniques that should be applied while using the RIA to obtain autologous bone graft from the femur. A large volume of bone graft, generally between 30 and 90 cm, can be obtained using a single RIA procedure. The bone graft harvested from the intramedullary canal is excellent regarding its biochemical properties, with several studies reporting higher levels of growth factors and stem cells when compared with iliac crest bone graft. Surgical technique is key to maximize bone graft harvest, as well as to avoid complications including iatrogenic fracture, intraarticular penetration, and fragmentation of either the reamer head from the drive shaft or the guide wire. Pearls and pitfalls regarding sizing of the reamer head, determination of starting point, guide wire placement, reamer advancement, and diligent use of fluoroscopic imaging are highlighted during this video. Finally, outcomes regarding healing of long bone defects when using RIA-derived autologous bone graft and reduction in postoperative pain at the graft donor site are briefly reviewed.