Utilization of a Clinic-Based Hand Surgery Procedure Room in the US Military Health System: A Performance Improvement Analysis of Resource Savings and Patient Satisfaction

DesRaj M Clark; Marvin E Dingle; Sean M Wade; Patrick K Mescher; George P Nanos 3rd; Scott M Tintle

doi:10.1016/j.jhsa.2023.03.014

Utilization of a Clinic-Based Hand Surgery Procedure Room in the US Military Health System: A Performance Improvement Analysis of Resource Savings and Patient Satisfaction

J Hand Surg Am. 2023 Jun 6:S0363-5023(23)00165-X. doi: 10.1016/j.jhsa.2023.03.014. Online ahead of print.

Authors

DesRaj M Clark¹, Marvin E Dingle², Sean M Wade², Patrick K Mescher², George P Nanos 3rd², Scott M Tintle²

Affiliations

¹ Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD. Electronic address: rajclark.uva@gmail.com.
² Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD.

PMID: 37294238
DOI: 10.1016/j.jhsa.2023.03.014

Abstract

Purpose: Recent studies examining the implementation of clinic-based procedure rooms (PRs) for wide-awake hand surgery have reported cost reduction, decreased burden on hospital systems, and improved patient satisfaction. This study evaluates other resource savings, primarily time spent by patients in the hospital.

Methods: Thirty-two patients were enrolled in a PR or the operating room group for prospective evaluation. Time spent in the hospital on the day of surgery, several preprocedure appointments, complications, and cost comparisons were evaluated between the two groups. Patient-reported outcomes were also evaluated with postoperative surveys assessing anxiety, pain, and satisfaction.

Results: Significant time savings were noted between the groups. The median time spent in the hospital on the day of surgery for the patients in the operating room group was 256 minutes versus 90 minutes for the PR group, a time savings of approximately 3 hours. Eight additional preoperative clinic visits for operating room patients were generated compared with no additional preoperative visits for PR patients. Cost savings for surgeries performed in the clinic-based procedure amounted to $232,411. No postoperative complications were observed in the clinic setting.

Conclusions: Continued utilization of the clinical PR for select hand surgery procedures will reduce the cost and time burdens for procedures while maintaining satisfaction and safety.

Clinical relevance: A clinic-based PR for performing minor hand surgeries saves the patient time and ostensibly allows the operating room to be used for more complex surgeries that are not easily amenable to a wide-awake in-clinic procedure.

Keywords: Health care resources; WALANT; procedure room.