Spine surgeon triage of new patient referrals: quantification of surgical conversion rate by clinic referral source

Zachary P French; Rajbir S Hundal; Anna C McGee; Alec E Winzenried; Seth K Williams

doi:10.1016/j.spinee.2024.03.009

Spine surgeon triage of new patient referrals: quantification of surgical conversion rate by clinic referral source

Spine J. 2024 Mar 16:S1529-9430(24)00112-8. doi: 10.1016/j.spinee.2024.03.009. Online ahead of print.

Authors

Zachary P French¹, Rajbir S Hundal², Anna C McGee³, Alec E Winzenried³, Seth K Williams³

Affiliations

¹ Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, 600 Highland Ave, Madison, WI 53792, USA. Electronic address: zfrench@uwhealth.org.
² Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, 600 Highland Ave, Madison, WI 53792, USA; Department of Orthopaedic Surgery and Rehabilitation, Wake Forest School of Medicine, 611 Lindsay St. Suite 100, 102 and 200, High Point, NC 27262, USA.
³ Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, 600 Highland Ave, Madison, WI 53792, USA.

PMID: 38499065
DOI: 10.1016/j.spinee.2024.03.009

Abstract

Background context: In an effort to efficiently deliver high-value spine surgical care, spine surgery clinics may triage new patient referrals. A triage system with attending surgeon review of referred patient images may improve the surgical conversion rate (SCR) of a spine surgical clinic, and shift the distribution of new patients in clinic toward those most likely to derive benefit from surgery.

Purpose: To quantify SCR and number of triage steps by referral source in a tertiary referral spine clinic where all referrals are triaged by attending surgeons.

Design: All spine surgery clinic patients seen for a new patient visit (NPV) at an academic medical center over a one-year period had their triage process and outcome (surgery or no surgery) reviewed.

Patient sample: The 1398 new adult patients seen for elective spine pathology were queried.

Outcome measures: SCR was defined as the percentage of new patients who underwent elective spine surgery within 18 months of NPV. Triage steps were defined as an action item by triage staff (ie, obtaining patient records) or by the patient (ie, undergoing additional imaging).

Methods: All new patient visits were evaluated for referral source, number of triage steps, and triage outcome. Time from referral to NPV, and time from NPV to surgery were also recorded. SCR, triage steps, and time-intervals were calculated for each surgeon and referral source and compared. Statistical analysis of variance (ANOVA) was used to ascertain differences.

Results: The overall SCR for the 4-surgeon group was 41.6%. This ranged among the surgeons from 24.7% to 60.1%. The referral sources with the highest SCR were in-system spine advanced practice providers (APPs) and in-system physical medicine and rehabilitation providers. Spine APPs also demonstrated the smoothest referral process, requiring the fewest steps.

Conclusions: Our findings provide a framework for assessment of triage processes at other institutions, as well as the impact of upgrades to our triage process as we work to improve triage efficiency. In the present study, referrals from providers familiar with spine pathology resulted in the highest SCR and fewest triage steps.

Keywords: Orthopedic clinic efficiency; Referral source; Spine APP; Spine clinic; Surgical conversion rate; Triage.