Specialty Referrals: Practical Pointers Kurt J. Nilsson, MD, MS St. Luke s Sports Medicine Medical Director, St. Luke s Concussion Clinic

Transcription

1 Specialty Referrals: Practical Pointers Kurt J. Nilsson, MD, MS St. Luke s Sports Medicine Medical Director, St. Luke s Concussion Clinic March 3, 2016

2 Disclosures The content of this presentation does not relate to any product of a commercial entity. I have no disclosures or conflicts or interest to report. 2

3 Objectives At the conclusion of this activity, participants will be able to discuss practical considerations when referring patients to musculoskeletal specialists, and perhaps describe specific diagnostic work up for patients prior to referral. 3

4 Communication What primary care docs wish specialists knew. What specialists wish primary care docs knew. 4

5 What do PCP s look for? Help determining when specialty referral is necessary. Help determining which specialist to send patient to. Timeliness of appointments. Avoiding unnecessary/costly interventions Communication 5

6 Knowledge vs system management If I knew what to do I wouldn t need to call you How do you make a system easier to access? 6

7 IPUs and you Standardized care pathways Integrated practice units 7

8 Where are we at St. Luke s? Maybe Boise is too small to worry St. Luke s Concussion Clinic does some of this stuff 8

9 St. Luke s Concussion Clinic Started with a problem: by the time referrals for concussion got to a neurologist, they were either fine or things were already disastrous. 9

10 St. Luke s Concussion Clinic How can we help determine when specialty referral is needed? How can we send to the correct specialists? How can we ensure timely access? How can we limit costs? How can we communicate? 10

11 St. Luke s Concussion Clinic First of all, call one number 11

12 St. Luke s Concussion Clinic How can we help determine when specialty referral is needed? 12

13 5/1/2012 6/1/2012 7/1/2012 8/1/2012 9/1/ /1/ /1/ /1/2012 1/1/2013 2/1/2013 3/1/2013 4/1/2013 5/1/2013 6/1/2013 7/1/2013 8/1/2013 9/1/ /1/ /1/ /1/2013 1/1/2014 2/1/2014 3/1/2014 4/1/2014 5/1/2014 6/1/2014 7/1/2014 8/1/2014 9/1/ /1/ /1/ /1/2014 1/1/2015 2/1/2015 3/1/2015 4/1/2015 5/1/2015 6/1/2015 7/1/2015 8/1/2015 9/1/ /1/ /1/2015 May 2012 November 2015 Total Calls 2917 Entered Clinic % Monthly Volumes *Initial_IntakesCompleted *I:EnteredClinic 13

14 St. Luke s Concussion Clinic How can we send to the correct specialist? 14

15 Breakdown by Specialty - Yearly Totals May 2012 November Referral Specialty Family Medicine Neurology Neuropsychological Testing Neurosurgery Occupational Medicine Physiatrist Sports Medicine 15

16 St. Luke s Concussion Clinic How can we ensure timely access? 16

17 90% of acute (< 2 weeks DOI) patients will be seen within three business days May 2012 November % 90.00% Appointment Scheduled 3 Business Days 95.21% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 4.79% Total 17

18 St. Luke s Concussion Clinic How can we limit costs? 18

19 May 2012 November 2015 Patients seen in Clinic < 18 years % % % % % % % % % % 0.00 % ED Visit With Medical Imaging Total Linear (Total) 19

20 St. Luke s Concussion Clinic How can we improve communication? 20

21 Mission and Role of St. Luke s Sports Medicine Concussion Clinic Define the value added by each specific specialty component of the clinic 21

22 Concussion Clinic Metrics Clinic metrics will be gathered and reported quarterly. 1. Metric: 90% of patients with acute concussions (< 2 weeks from date of injury) will be seen within 3 business days. **For single specialty providers or providers outside of the Treasure Valley, appropriate exceptions will be made. How: Data for this metric will be gathered via the Concussion Clinic Dashboard. 2. Metric: The following outcome measures will be completed and supporting documentation will be scanned into Epic 75% of the time. Initial Evaluation Rivermead Post Concussion Symptoms Questionnaire will be administered at each visit and scanned into Epic. Each visit note will include RPQ-3, RPQ-13 and Total Score. Verbal and written education material on concussion will be provided at the initial visit (yes, no, n/a) Return to learn and/or return to work accommodations provided at the initial eval (yes, no, n/a) Clearance provided for full return to school (yes, no, n/a) Medical clearance for return to sport (yes, no, n/a) Follow-up visit plan Follow-up Visits Rivermead Post Concussion Symptoms Questionnaire will be administered at each visit and scanned into Epic. Each visit note will include RPQ-3, RPQ-13 and Total Score. Return to learn and/or return to work accommodations update provided at the of followup visit (yes, no, n/a) Clearance provided for full return to school (yes, no, n/a) Medical clearance for return to sport (yes, no, n/a) Follow-up visit plan How: Data for this metric will be abstracted from provider notes in Epic. 3. Metric: 65% or more of patients will agree or strongly agree on the patient satisfaction survey question: When I met with the physician, information and instructions were clearly explained and accurate? How: Data for this metric will be gathered from the Concussion Clinic Patient Satisfaction Survey in Survey Monkey. 4. Metric: Providers will attend two-thirds of scheduled Concussion Clinic Sports Medicine provider meetings annually. How: Data for this metric will be gathered from attendance sign-in sheets at each meeting. 5. Metric: Providers will see a minimum of 20 Concussion Clinic patients annually. **For providers outside of the Treasure Valley, this number may be amended based on various factors. How: Data for this metric will be gathered via the Concussion Clinic Dashboard. 22

23 Access and coordination So can we apply this to MSK medicine? Diagnosis driven Is access easy here? We already have operative and nonoperative MD, PA, PT, ATC Creating standardized care pathways Harnassing the powers of EHR for good Developing quality metrics 23

24 Here are the practical pointers: 24

25 Be able to describe fractures on the phone Where it is, what it is, how it is Length Angulation Displacement Rotation 25

26 Get weight bearing xrays whenever possible, and always before MRI Supine Weight bearing 26

27 Recognize that stiff shoulders are either adhesive capsulitis OR osteoarthritis 27

28 Questions and Answers 28