scholarly journals Decreasing Radiograph Errors in Pediatric Sports Medicine Clinic

2018 ◽  
Vol 3 (4) ◽  
pp. e089 ◽  
Author(s):  
Amy E. Valasek ◽  
James Gallup ◽  
T. Arthur Wheeler ◽  
Jahnavi Valleru
2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0041
Author(s):  
Alfred Atanda ◽  
Kathryn Leyden ◽  
Medical Student

Objectives: Gathering of background information during a clinic visit can be time-consuming. Some medical specialties have workflows that pre-screen patients ahead of time to minimize delays. Having background information ahead of time may decrease delays and ensure that the visit is focused on physical examination, diagnosis, and treatment. We have used telemedicine to treat established patients to reduce cost and resource utilization, while maintaining high levels of patient satisfaction. It is conceivable that telemedicine could also be used to pre-screen new patients prior to their in-person clinic visit. The goal of the current study was to evaluate whether utilizing telemedicine to pre-screen new patients to our sports medicine clinic would reduce time in the exam room waiting and being seen, and overall clinic times. Methods: From June 2018 through August 2018, we utilized videoconferencing telemedicine to pre-screen all new patients to a pediatric sports medicine clinic with a chief diagnosis of knee pain. Visits were performed by full-time telemedicine pediatricians who were provided appropriate training and an intake form describing which questions should be asked. All visits utilized the American Well software platform (Boston, USA) and were performed on the patient’s personal device. During the subsequent in-person visit, the overall timing of the visit was recorded including: time checked in, time waiting in waiting room, time waiting in exam room, time spent with provider, and time-checked out, were all recorded. Similar time points were recorded for matched control patients that did not undergo telemedicine pre-screening and were seen in the traditional manner. Inclusion criteria included: being brand new to the practice and unilateral knee pain. Results: There were eight pre-screened patients and ten control patients in this cohort. Compared to controls, pre-screened patients spent less time in the exam room (19 min vs. 31 min), higher percentage of the exam room time with the provider (58% vs. 34%), higher percentage of the overall visit time with the provider (29% vs. 19.5%), and less time for the overall visit (39 min vs. 52 min). Conclusion: Pre-screening patients to obtain background information can decrease exam room waiting time and overall visit time and maximize time during the visit spent with the provider. In addition, it could potentially be used to increase throughput through the clinic and improve patient satisfaction scores.


1985 ◽  
Vol 13 (6) ◽  
pp. 168-176
Author(s):  
Heyward L. Nash

2018 ◽  
Vol 37 (2) ◽  
pp. 351-362 ◽  
Author(s):  
Joel B. Huleatt ◽  
Carl W. Nissen ◽  
Matthew D. Milewski

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0021
Author(s):  
Julie A. Young ◽  
Amy E Valasek ◽  
James Onate

The benefits of physical activity cross all domains of health. Unfortunately, many children are not meeting the current American College of Sports Medicine recommendations of 60 minutes of moderate to vigorous physical activity (MVPA) 7 days a week. This is especially deleterious since physical activity patterns during childhood may carryover to adulthood. Research has also shown that participating in one sport may increase the risk of injury. The purpose of this study was to examine self-reported exercise levels in children reporting to a tertiary sports medicine clinic over a three year period. Subjects were asked “How many minutes of moderate to vigorous physical activity per day?” and “How many days per week do you participate in moderate to vigorous physical activity”. Minutes per week of MVPA was calculated. Age, sex, and current sports and recreational activities were recorded. There were 7427 unique patients (53% female) with an average age of 13.8±2.6. The average minutes per day of exercise was reported as 85.6±44.4, average days per week was 4.4±1.6 and minutes per week was 410.8±266.9. Females reported less minutes per day (83.5 vs. 87.8, p<.001), less days per week (4.2 vs 4.7, p<.001) and less minutes per week (384.1 vs 440.2, p<.001) than males. On average, females reported 56 minutes less activity per week than their male counterparts. There were 3618 participants who only reported one activity and were categorized as specialized in a single physical activity. Those that specialized in a single activity were significantly older (14.1 vs 13.4, p<.001). There were no significant differences between reported minutes per day between specialized and unspecialized athletes (85.8 vs 85.2, p=.57). Those who specialized in one activity reported more days per week (4.6 vs 4.2. p<.001) and more minutes per week (423.8 vs 397.0, p=.001) than unspecialized athletes. Research has consistently shown that females are less active than males. Those who specialized in one activity participated in more minutes per week of activity, mainly through participating in more days of physical activity. Children should be encouraged to participate in a variety of activities on a daily basis to ensure they receive the benefits of physical activity.


2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0003
Author(s):  
Meagan J. Sabatino ◽  
Catherine V. Gans ◽  
Aaron J. Zynda ◽  
Chan-Hee Jo ◽  
Jane Chung ◽  
...  

Background: In orthopedics, patient reported outcome measures (PROMs) have become popularized due to an increase in patient-centered research and pay for performance reimbursement models. Most pediatric PROMs have been utilized and validated in paper format. However, the use of a computer-based system may improve patient and physician efficiency, decrease cost, ensure completion, provide instantaneous information, and minimize inconvenience. The purpose of the study is to validate the use, evaluate patient satisfaction, and review differences of electronic compared to paper PROMs in a pediatric sports medicine practice. Methods: New patients between 12 – 19 years of age with a knee-related primary complaint were identified prior to their appointment. Patients were then randomized into two groups to complete standard clinical PROMs; including the Pedi-IKDC, HSS Pedi-FABS, Tegner Activity Scale, Visual Analogue Scale (VAS) and PedsQL-Teen. Group 1 completed paper forms followed by electronic, while Group 2 received the electronic format followed by paper, with a 10-minute break between formats in each group. Following the completion of PROMs, subjects completed a satisfaction survey. A Pearson’s correlation was used to calculate the association between the measures and a paired t-test to compare means between electronic and paper forms. Reliability analysis was conducted using an ICC calculation. Results: 87 subjects were enrolled with one excluded due to incomplete PROMs, for a total of 86. 54 subjects were female and 32 were male with an average age of 14.3 years (range 12-18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC, HSS Pedi-FABS, PedsQL 13-18 and the Tegner activity scale (Figure 1). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 vs 4.6, p<0.001). Excluding the 10-minute break, it took subjects an average of 21.3 minutes to complete the PROMs. Although not significant, electronic PROMs took less time than paper on average (10.0 min vs 11.2 min, p=0.096). All subjects endorsed that PROMs captured on paper were the same as electronic with 69.8% of subjects preferring the electronic PROMs. 67.4% of subjects reported they felt the electronic format was faster, with only 5.8% of patients reporting the electronic forms were hard or confusing. 93.0% stated they would complete forms at home prior to appointments if it were an option and 91.8% were not concerned about the safety/privacy of electronic forms. Conclusion/Significance: PROMs captured electronically were reliable and valid when compared to paper, with differences noted only on the VAS. Electronic PROMs may be quicker, will not require manual scoring, and are preferred by patients. Electronic PROMs will improve the clinician’s ability to collect complete and validated data while reducing the burden on the clinical staff and patients. [Figure: see text]


2017 ◽  
Vol 49 (5S) ◽  
pp. 707
Author(s):  
Bridget J. Quinn ◽  
Rebecca L. Zwicker ◽  
Dai Sugimoto ◽  
Andrea A. Stracciolini

2012 ◽  
pp. 3945-3952
Author(s):  
Mary K. Mulcahey ◽  
Keith O. Monchik ◽  
Michael J. Hulstyn ◽  
Paul D. Fadale

2018 ◽  
Vol 46 (13) ◽  
pp. 3254-3261 ◽  
Author(s):  
David R. Howell ◽  
Roger Zemek ◽  
Anna N. Brilliant ◽  
Rebekah C. Mannix ◽  
Christina L. Master ◽  
...  

Background: Although most children report symptom resolution within a month of a concussion, some patients experience persistent postconcussion symptoms (PPCS) that continues for more than 1 month. Identifying patients at risk for PPCS soon after an injury can provide useful clinical information. Purpose: To determine if the Predicting Persistent Post-concussive Problems in Pediatrics (5P) clinical risk score, an emergency department (ED)–derived and validated tool, is associated with developing PPCS when obtained in a primary care sports concussion setting. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a study of patients seen at a pediatric sports medicine concussion clinic between May 1, 2013, and October 1, 2017, who were <19 years of age and evaluated within 10 days of a concussion. The main outcome was PPCS, defined as symptoms lasting >28 days. Nine variables were used to calculate the 5P clinical risk score, and we assessed the association between the 5P clinical risk score and PPCS occurrence. The secondary outcome was total symptom duration. Results: We examined data from 230 children (mean age, 14.8 ± 2.5 years; 50% female; mean time from injury to clinical assessment, 5.6 ± 2.7 days). In univariable analyses, a greater proportion of those who developed PPCS reported feeling slowed down (72% vs 44%, respectively; P < .001), headache (94% vs 72%, respectively; P < .001), sensitivity to noise (71% vs 43%, respectively; P < .001), and fatigue (82% vs 51%, respectively; P < .001) and committed ≥4 errors in tandem stance (33% vs 7%, respectively; P < .001) than those who did not. Higher 5P clinical risk scores were associated with increased odds of developing PPCS (adjusted odds ratio [OR], 1.62 [95% CI, 1.30-2.02]) and longer symptom resolution times (β = 8.40 [95% CI, 3.25-13.50]). Among the individual participants who received a high 5P clinical risk score (9-12), the majority (82%) went on to experience PPCS. The area under the curve for the 5P clinical risk score was 0.75 (95% CI, 0.66-0.84). After adjusting for the effect of covariates, fatigue (adjusted OR, 2.93) and ≥4 errors in tandem stance (adjusted OR, 7.40) were independently associated with PPCS. Conclusion: Our findings extend the potential use for an ED-derived clinical risk score for predicting the PPCS risk into the sports concussion clinic setting. While not all 9 predictor variables of the 5P clinical risk score were independently associated with the PPCS risk in univariable or multivariable analyses, the combination of factors used to calculate the 5P clinical risk score was significantly associated with the odds of developing PPCS. Thus, obtaining clinically pragmatic risk scores soon after a concussion may be useful for early treatments or interventions to mitigate the PPCS risk.


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