Increasing Follow-up Visits for Operative Orthopaedic Patients

An initiative using improvement science more than doubled the number of operative orthopaedic trauma patients returning to the hospital for crucial follow-up visits.

Follow-up visits after pediatric orthopaedic injuries are important because of potential long-term effects. If an injury doesn’t heal properly, it can affect a child negatively in adulthood.

However, the operative orthopaedic trauma population has a low rate when it comes to follow-up visits. This can be attributed to a lack of long-standing relationship between surgeon and patient, a parent’s failure to understand the importance of follow-up visits, and/or a lack of standardized practice among surgeons in carrying out follow-up visits.

Orthopaedic surgeon Jaime Rice Denning, MD, MS, knows how crucial follow-up is and saw a gap in return visits in her own patient population at Cincinnati Children’s. So she embarked on a project using improvement science to transform the delivery of care. “We wanted to optimize our chances that we would get patients back in for follow-ups, and get them back in at the right time,” Denning says.

Improvement Science Helps ID Obstacles

To learn how to implement such change successfully, Denning took an improvement science course through the medical center’s James M. Anderson Center for Health Systems Excellence. The course teaches a methodology to transform health systems by evaluating current practices, identifying needed changes, and creating a plan to achieve that change.

Baseline data over three months showed that just 14 percent of trauma patients had a follow-up appointment made before they were discharged from the hospital. Denning formed a team that determined the best way to achieve a higher follow-up rate: by making post-op appointments before patients left the hospital after surgery. They set a goal of raising that figure to 80 percent.

The team identified key drivers to have a safe and effective discharge. Changes involved educating and engaging the team, adding a reminder to the inpatient list, and analyzing failures and holding each person accountable for those failures.

“The team really took that to heart,” Denning explains. “They all wanted to succeed and there was a solid effort to improve for the safety of our patients.”

Results Show Significant Progress

After six months of putting the changes into practice, the team saw 73 percent of patients with follow-up appointments made prior to discharge, an increase of 59 percent. The number of operative orthopaedic trauma patients who followed up at the correct time interval after surgery rose by 20 percent.

“I’m really proud of the fact that we were able to accomplish our global aim of increasing follow-up visits,” Denning says. “It was a real group effort and shows the dedication of our team to improve the care we provide for our patients.”

Denning continues to track progress in this area and is happy to report the team is maintaining these results. Currently 95 percent of trauma patients are following up at the correct post-operative time interval. The group is now working on plans to spread what they learned beyond trauma patients to non-operative patients and other divisions within the medical center.

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