SPOT CHECK Orthopedic surgeon William Enright, MD, of Orthopedic and Sports Medicine Specialists, reads the X-rays of a patient who sought care at his practice's acute injury clinic.

People who break bones or tear joints after business hours usually head to the local ER, where they're likely to wait hours to see a caregiver who isn't an expert in orthopedics. But a growing number of injured patients are seeking out orthopedic urgent care centers, where they're able to sidestep the wait and hassle of the ER in favor of fast and efficient care delivered by bone and joint specialists. For orthopedic practices, outpatient trauma care is proving to be a great way to capture surgical patients.

Convenience is key
Orthopedic and Sports Medicine Specialists (OSMS) of Green Bay (Wis.), attached a 6-room acute injury clinic to the practice's surgery center 2 years ago to offer members of the community an alternative to long waits in the ER. Patients rarely have to wait more than 30 minutes to be seen at the OSMS acute injury clinic, says Administrator Sandy Fragale, CPA.

The clinic and surgery center share some equipment and the radiology staff. Nurses and surgical techs sometimes walk down the hall to work in both locations. Up to 5 surgeons work in the clinic, which is open Monday through Friday from 8 a.m. to 5 p.m. Not surprisingly, Monday mornings and Friday afternoons are the busiest times as patients want to be seen before or after the weekend. Ms. Fragale says her surgeons are considering staying open beyond normal business hours.

OA Centers for Orthopaedics in Portland, Maine, opened its OrthoAccess walk-in clinic last February, partly because the group was aware patients will often seek out care where they can be seen the soonest, says Alison Lee, DO, a primary care sports medicine physician.

"There are a ton of orthopedic issues that are non-emergent that don't need to be treated in the ER," says Dr. Lee. "And even if patients do go to the ER, they often end up being referred to us. Now they see us directly."

OrthoAccess is open 1 p.m. to 8 p.m. Monday through Friday and 9 a.m. to 2 p.m. Saturday. Ex-tending the clinic's hours into weekday evenings offers patients convenient after-work access to care, says Dr. Lee.

The wait is often shorter than it would be at the local ER, although there's sometimes a logjam of patients on Monday afternoons, typically the clinic's busiest day of the week. The clinic treats 15 to 20 patients per day.

NEW BUSINESS
Recruiting Patients for Surgery

FIRST IMPRESSION Urgent care clinics provide surgeons like James Grace, MD, of Orthopedic and Sports Medicine Specialists, with access to new patients.

The patients who have their acute injuries treated at orthopedic walk-in clinics might someday return for surgery, whether it's to repair the injury that brought them to the clinic or to return to a familiar group of surgeons for future care. That's a big reason OA Centers for Orthopaedics, which opened a walk-in clinic earlier this year in Portland, Maine. "It's a good business model to build access to new patients," says Alison Lee, DO, a primary care sports medicine physician at OA.

Sandy Fragale, CPA, the administrator of Orthopedic and Sports Medicine Specialists of Green Bay (Wis.), says her group's acute injury clinic gives them "access to patients we might not otherwise see."

— Daniel Cook

READY FOR ANYTHING Caregivers at walk-in clinics treat a variety of injuries and patients of all ages.

They see it all
OSMS's surgeons see an average of 100 orthopedic trauma cases per month, everything from minor sprains and strains to acute compound fractures. If the surgeons can't treat an injury on the spot, they do their best to connect patients with a specialist who can see them that day. The detached finger carried in by a patient? He (and his finger) were sent to the local emergency room. "We try to take care of everyone," says Ms. Fragale, "but that's one that should have been in the ER to begin with."

Treating urgent care patients ultimately bumps up case volumes in OSMS's surgery center (see "Recruiting Patients for Surgery"). In some instances, patients with serious injuries such as exposed fractures can be operated on the same day they enter the clinic, depending on preauthorization from their insurance carriers. Patients who need follow-up surgery often come back to the surgery center to have the procedure performed.

Dr. Lee and her colleagues treat patients of all ages — as young as 4 years to as old as 97 years so far — who show up with a variety of ailments, although most are injuries to the hand, wrist, ankle and knee. She recently treated a woman with an acute wrist fracture. She X-rayed the joint, reduced the fracture, braced the wrist and scheduled the patient for a follow-up appointment with one of the practice's wrist specialists. It's OA policy that patients who need follow-up surgical care meet with one of the group's surgeons within 48 hours of their visit to the clinic.

Dr. Lee has also seen her share of serious injuries. She coordinated care with the on-call ortho doc at the local emergency room for a patient with a hip fracture that needed to be pinned immediately and also sent a patient with a possible skull fracture for an emergency CT scan. "We're not here for emergencies, we're here for urgent orthopedic issues," says Dr. Lee. "Urgent means something different to everyone."

Case in point: Dr. Lee recently saw a man complaining of chronic hip pain that lingered from a hip fracture he suffered 3 years ago. His case represents an interesting dilemma for facilities and practices interested in running an urgent care clinic of their own: How do you keep space open for truly emergent cases and not turn away any potential patient? Where do you draw the line between emergent and non-emergent care?

"That's a skill we're going to have to develop as we get busier," says Dr. Lee "It's going to require finessing triage so we're spending time with the patients who truly need on-the-spot care and coordinating the next step of care for patients with chronic pain, which can be an urgent matter for them."

Word of mouth
Dr. Lee says getting the word out about the practice's walk-in clinic has required a great deal of local marketing, which included a television spot (starring Dr. Lee!), a social media presence, print materials and radio ads, which surprisingly have been the most effective. The practice has also reached out to local athletic trainers, physical therapists and primary care physicians to make them aware of the service. "Once you get things rolling, word of mouth becomes your best marketing tool," says Dr. Lee. "We're starting to see that now."

Ms. Fragale can vouch for that. She says demand for OSMS's urgent orthopedic care has exploded since the practice began offering it 2 years ago, thanks to satisfied patients telling their friends and family about walking in and having their injuries treated almost immediately. Ms. Fragale is one of those satisfied patients. Last November, she blew out her ACL and limped into the clinic, where a doc scheduled an MRI and braced her knee. A month later, Ms. Fragale had the ligament repaired in the practice's surgery center. What did she learn from the experience? It's simple: No one wants to go to the ER. OSM