Initial Evaluation by a Non-Surgeon Provider Does Not Delay the Surgical Care of Pediatric Forearm and Elbow Trauma in a Walk-In Orthopaedic Clinic.

Abstract

IntroductionWalk-in and after-hours clinics are being increasingly utilized in orthopedics and are especially beneficial for patients with simple sprains, fractures, or overuse injuries that might otherwise require an emergency room visit. To meet the increased patient load, additional staffing often is required, which might include a family medicine physician, nurse practitioner, or physician assistant. Few studies have evaluated the performance of these non-surgeon providers in an orthopedic clinical setting. This study compared the time to definitive care of pediatric patients with forearm and elbow injuries between non-surgeon providers in a walk-in clinic, orthopedic surgeons in a walk-in clinic, and a pediatric orthopedic surgeon in a regular clinic.MethodsChildren who had closed reduction and fixation of an elbow or forearm injury from January 2010 to December 2017 were identified. The patients were divided into groups: patients initially evaluated in a walk-in clinic by a non-surgeon provider; patients initially evaluated in a walk-in clinic by an orthopedic surgeon; and patients initially seen by a fellowship-trained, pediatric orthopedic surgeon in a regular clinic (control group). Neither type of provider (non-surgeon or surgeon) in the walk-in clinics definitively treated any injury but rather transferred care of the patient to a pediatric orthopedic surgeon. The number of clinic visits until surgery, the number of providers seen, the days before evaluation by a pediatric orthopedic surgeon, and the number of days before definitive surgical treatment were documented.ResultsOf the 162 patients identified, 36 (22%) were initially seen by an orthopedic surgeon and 62 (38%) by a non-surgeon provider in a walk-in clinic. The remaining 64 (40%) (control group) were initially seen in a regular office visit by a pediatric orthopedic surgeon. There were no significant differences noted for patients treated by orthopedic surgeon and non-surgeon providers in days before a referral visit to the pediatric orthopedic surgeon (3.7 vs. 3.9, respectively; p = 0.63) or days to surgery for definitive treatment (5.2 vs. 4.8, respectively; p = 0.62). The average number of providers seen (1.58 vs. 1.63, respectively; p = 0.69) and average number of clinic visits before surgery (2.08 vs. 2.06, respectively; p = 0.76) also were similar when comparing the two groups. The control group had significantly fewer days from evaluation to surgical treatment than the surgeon walk-in group (3.3 days vs. 5.2 days, p < 0.05) and the non-surgeon walk-in group (3.3 days vs. 4.8 days, p < 0.05).ConclusionThere was no difference in the number of days to transfer patient care to a pediatric orthopedic surgeon between non-surgeon providers and orthopedic surgeons in the walk-in clinic. However, there was a one-day delay reaching definitive treatment when initial evaluation occurred in a walk-in clinic, regardless of whether the patient was initially seen by a surgeon or non-surgeon, when compared to an initial evaluation by a pediatric orthopedic surgeon.