Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, 600 Highland Ave, Madison, WI 53792, USA.
Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, 600 Highland Ave, Madison, WI 53792, USA; Department of Orthopaedic Surgery and Rehabilitation, Wake Forest School of Medicine, 611 Lindsay St. Suite 100, 102 and 200, High Point, NC 27262, USA.
Spine J. 2024 Aug;24(8):1478-1484. doi: 10.1016/j.spinee.2024.03.009. Epub 2024 Mar 16.
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.
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.
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.
The 1398 new adult patients seen for elective spine pathology were queried.
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).
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.
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.
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.
为了高效提供高价值的脊柱外科护理，脊柱外科诊所可能会对新患者进行分诊。采用主治医生审查转诊患者影像的分诊系统，可能会提高脊柱外科诊所的手术转化率（SCR），并使诊所中新患者的分布向最有可能从手术中获益的患者倾斜。
在一家三级转诊脊柱诊所中，对所有转诊患者均由主治医生进行分诊，通过转诊来源量化 SCR 和分诊步骤数量。
在一年期间，对学术医疗中心的所有新患者就诊（NPV）脊柱外科门诊患者的分诊流程和结果（手术或非手术）进行回顾性研究。
对 1398 例因择期脊柱病变就诊的成年新患者进行了调查。
SCR 定义为 NPV 后 18 个月内接受择期脊柱手术的新患者比例。分诊步骤定义为分诊人员的操作项目（例如，获取患者记录）或患者的操作项目（例如，进行额外的影像学检查）。
对所有新患者就诊的转诊来源、分诊步骤数量和分诊结果进行评估。记录从转诊到 NPV 的时间，以及从 NPV 到手术的时间。计算每位医生和每个转诊来源的 SCR、分诊步骤和时间间隔，并进行比较。采用方差分析（ANOVA）进行统计学分析以确定差异。
4 位医生小组的总体 SCR 为 41.6%。这在医生之间的范围从 24.7%到 60.1%。SCR 最高的转诊来源是院内脊柱高级实践提供者（APP）和院内物理医学和康复提供者。脊柱 APP 也表现出最顺畅的转诊流程，所需步骤最少。
我们的研究结果为其他机构评估分诊流程提供了框架，也为我们改进分诊效率的过程中升级分诊流程提供了影响评估。在本研究中，来自熟悉脊柱病理学的提供者的转诊导致了最高的 SCR 和最少的分诊步骤。
