Initial evaluation by a nonsurgeon provider does not delay the surgical care of operative ankle fractures in a walk-in orthopaedic clinic: A retrospective cohort study

Abstract

Background: Orthopaedic walk-in and after-hours clinics may be staffed by orthopaedic surgeons, nonsurgeon physicians, advanced practice nurses, or physician assistants. This study assessed whether initial evaluation by a nonsurgeon delays the care of patients with ankle fractures that require surgery compared to initial evaluation by an orthopaedic surgeon. Methods: Patients evaluated in an orthopaedic walk-in clinic who subsequently had surgery for an isolated ankle fracture were identified and were divided based on whether initial evaluation was by an orthopaedic surgeon or a nonsurgeon provider. Patients evaluated and subsequently treated by a fellowship-trained foot and ankle surgeon in his/her private practice served as a control group. Outcome measures included number of clinic visits before surgery, number of providers seen, days until evaluation by a treating surgeon, and days until definitive surgical management. Results: Of 138 patients evaluated in a walk-in clinic who subsequently had surgical fixation of an ankle fracture, 61 were seen by an orthopaedic surgeon and 77 by a nonsurgeon provider. No significant differences were found between patients initially evaluated by surgeons and those evaluated by nonsurgeons in days to evaluation by treating surgeon or days until definitive surgical treatment. The average numbers of providers seen and clinic visits before surgery were similar. Patients evaluated and treated only in a single foot and ankle surgeon’s practice had significantly fewer clinic visits and fewer days between evaluation and surgery than the walk-in groups. Conclusions: Initial evaluation in a walk-in orthopaedic clinic setting is associated with a longer time between initial evaluation and treatment compared to a single foot and ankle surgeon’s clinic, but this difference may not be clinically significant. Initial evaluation by a nonsurgeon provider is not associated with an increased time to definitive treatment compared to evaluation by an orthopaedic surgeon in a walk-in clinic. Level of Evidence: Level III.