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Surgery and Perioperative Care Clinical Programs

Launching New Models of Care: Musculoskeletal Institute

Musculoskeletal disease is one of the most common conditions affecting Americans today, which is why the Department of Surgery and Perioperative Care chose it as one of its first areas of focus in care. The department works closely with clinical experts on its faculty to design evidence-based, person-centered care pathways that focus on helping people get and stay healthy.

The Musculoskeletal Institute, launching in fall 2017, provides care for everything from severe osteoarthritis to mild ankle sprains. The team of experts includes orthopaedic surgeons, physiatrists, associate providers (for example, nurse practitioners and physician assistants), physical therapists, social workers, and nutritionists. By bringing together these experts, the department can better ensure that patients will be connected with the right provider at the right time to address their specific needs and preferences.

Improving the Health of Our Community Through Care Redesign

Musculoskeletal: A year ago, the wait time to see a musculoskeletal provider for uninsured and underinsured patients in Travis County was more than a year. More than 1,400 patients were on a waiting list for a specialist appointment. Now, through a collaborative effort of Dell Medical School, Ascension’s Seton Healthcare Family and the Community Care Collaborative, patients receive care within a few weeks.

To achieve this, the Surgery and Perioperative Care team developed targeted strategies to address the key challenges limiting access. First, it developed a new triage process that included a nurse practitioner’s review of all referrals to evaluate severity and need. It also added additional clinical hours to address the demand for services and began offering real-time assistance to primary care providers to better equip them to manage patients who don’t yet need to see a specialist.

Most recently, the department added virtual visits and self-care programs for patients to enable treatment at home. The clinic, located in the Paul Bass Clinic in the basement of the retiring University Medical Center Brackenridge, will move to the Health Transformation Building in the fall and will become a part of the Musculoskeletal Institute

Urology: In early 2017, Dell Medical School expanded its care redesign efforts to include urology. The Surgery and Perioperative Care team in partnership with Seton Healthcare Family and the Community Care Collaborative developed new referral protocols for primary care providers to better define what conditions can be managed by primary care and what conditions are better suited for specialist management.

Additionally, the team is developing an active referral management approach that includes triaging patients based on clinical need to ensure timely access and streamlining new referrals so that patients are connected with the right providers.

Launching Virtual / Self-Care Programs

A new state law signed in 2017 opened doors to broader implementation of telehealth. With its passage, providers in the department’s musculoskeletal clinic have started to offer virtual visits prior to (or instead of) an in-person visit when appropriate.

For example, patients referred for orthopaedic specialty care related to an upper extremity problem are contacted by phone and given the option to schedule a virtual video or telephone visit. This initial phone contact allows for earlier contact at the patient’s convenience, enables better access to a specialist provider and gives the patient time to review diagnosis information and decision aids — or even to start his or her own self-care plan prior to the virtual or in-person visit. 

Improving Communication between Providers and Patients

In an effort to make a visit to the specialist more personal and engaging, the team is developing ways to start the visit with a conversation that defines the patient’s goals by understanding what brings meaning, support and joy to that person’s life. A visit to the doctor usually means something is in the way of these core values and activities. The department has developed a short, semi-structured conversation template and has recruited undergraduate volunteers to help develop and expand its use. 

Together with Center for Health Communication colleagues and local motivational interviewing experts, Surgery and Perioperative Care is piloting communication skill-building sessions with musculoskeletal clinical teams. The goal is to better equip providers so that they can more effectively communicate with their patients. Eventually, this training will be available to care teams in other medical specialties as well.