Enhancing Clinic Efficiency: A Quality Improvement Initiative for Postoperative Patient Care in an Outpatient Orthopedic Physician Practice Setting

Authors

D Stepan, Drake University, Des Moines, IA
T JP Greffly, Illinois Bone and Joint Institute, Morton Grove, IL
R M. Williams, Drake University, Des Moines, IA

Keywords

Athletic Trainers in Physician Practice Society Meeting and Conference 2025

Abstract

Introduction: Following orthopedic surgery, patient post-operative (post-op) visits are deemed global surgical observations where day 00 to day 90 are appointments that cannot be billed. Patients are typically seen 3 times during this global period. Thus, the outpatient clinic needs to have non-billable time slots each day for these patients. The current scheduling model double books patients every 15 minutes, with the physician being the primary provider seeing patients for post-op visits. Therefore, the clinic has demonstrated inefficiencies with scheduling these patients while having sufficient appointments available for billable patients. This quality improvement initiative aimed to decrease post-op patient visits to create open appointments for billable patients. Aim: Over a two-week implementation period, post-op patient visits will decrease by 15 minutes. Outcome Measures: Global post-op patient visits were tracked for time from entry into the exam room to visit completion using the clinic’s electronic medical record system. Patient surgery type and encounters (e.g., radiographs, wound care, history) were also tracked. PDSA Cycle: (Plan): The quality improvement project implemented a new protocol for placing post-op patients’ charts on top of the “to be seen pile” after encounters were completed to decrease time in clinic for this patient population. (Do) We engaged in a two-week implementation period. (Study): The data collected from this cycle showed an average decrease in clinic time of 19.68 minutes for post-op patients. (Act) This project demonstrated that the intervention was effective and should be enacted. Future cycles should test if there are other ways to decrease times in-clinic, such as improving radiograph efficiency and improving scheduling to accommodate an additional 15-minute appointment for a billable patient to be seen. Results: Following implementation of this project, clinic time was reduced for post-op patients from 58.81 minutes to 39.13 minutes. Prior to implementation, knee arthroscopy clinic time averaged 46.75 minutes and then decreased to 30.50 minutes. Anterior cruciate ligament (ACL) reconstruction clinic time was reduced by 9.67 minutes, followed by total knee arthroplasty (TKA) reduced to 20.53 minutes, and other procedures reduced by 69.10 minutes. The Total hip arthroplasty (THA) clinic time increased by 2.67 minutes. During the project, there were 12 post-op patients seen: 3 ACL, 14 TKA, 3 THA, and five others. Throughout the entire data collection, 70 patients were seen: 32 patients were seen before the intervention; 38 patients were seen during the intervention (Figure). Discussion: Overall, most post-op patient clinic time was decreased throughout the implementation window. The intervention was effective in creating a more efficient clinic. This quality improvement project can be adopted to create more appointments for billable patients, as well as adapted to see if there are other changes that can be made to further decrease unbilled time within the clinic.

Recommended Citation

Stepan, D; Greffly, T JP; and Williams, R M. (2025) "Enhancing Clinic Efficiency: A Quality Improvement Initiative for Postoperative Patient Care in an Outpatient Orthopedic Physician Practice Setting," Clinical Practice in Athletic Training: Vol. 8: Iss. 1, Article 14.
Available at: https://scholars.indianastate.edu/clinat/vol8/iss1/14