Smoother Process for Orthopedic Referrals Leads to Improved Care and Increased Satisfaction Among Patients Receiving Physical Therapy

An aching back. A broken bone. Nagging arthritis.

Musculoskeletal pain is the chief reason why people visit their doctors who often refer them to orthopedic specialists.

Riverside Health System’s comprehensive orthopedic care embraces an integrated approach to best serve its patients. Riverside Orthopedic & Sports Medicine Specialists and Riverside Physical Therapy centers work closely together to maximize their shared patients’ outcomes.

Completing timely physical therapy when prescribed can be a proactive measure to delay or avoid surgery or be an essential component of a post-operative treatment plan. As many as three-quarters of patients who receive physical therapy at Riverside are referred by orthopedic specialists.

The majority come from its largest practice in the Medical Office Building in Newport News. Outpatient Therapy is located on the first floor of that building; Orthopedics & Sports Medicine occupies all of the third floor and some of the fourth.

“Having that proximity and that relationship are key because of the amount of patients that both of us see,” said Will Parker, Riverside’s Director of Outpatient Therapy. “The overlap is significant.”

Reversing a Trend

Yet Parker noticed a troubling pattern while examining statistics from a six-month period in 2019.

Only 46% of orthopedic patients referred from Riverside’s Newport News office to physical therapy actually completed their initial visit. The average appointment lag, or time between the appointment being scheduled through the actual visit date, was 12 days. Of the scheduled referrals, 38% canceled or didn’t show for their initial visit, and 25% of the total referrals never scheduled at all.

The Net Promoter Score, a measure that indicates patient satisfaction, for the specified timeframe was 77.8%.

Parker determined those numbers needed to improve on all fronts, noting, “Timely access to care was the critical component here.”

Patients forced to wait a long time to receive physical therapy are less likely to come. Increased wait times correlate with increased cancellation rates. Parker knew an improved process needed to decrease lag time and be convenient for both patient and the referring specialist.

“Our goal was to provide same-day availability options as a way of reducing our average appointment lag by 30%,” he said.

A Unique Solution

Patients who receive a referral for physical therapy can schedule their appointments in one of four ways. They can phone either Riverside Outpatient Services or its Central Scheduling office. The Physical Therapy clinic can reach out to the patient.

The fourth option — a referring physician’s office can schedule the physical therapy appointment upon patient checkout — was the area that Parker earmarked for change.

“If physical therapy can be scheduled immediately, it’s more likely to be attended,” he said.

But limited availability on Riverside’s physical therapy schedule created a barrier that discouraged its orthopedic office team to use this method routinely.

Parker devised a solution using iCare, the documentation system that is standard across all Riverside locations.

“We created a unique visit type in iCare for our patients referred by our orthopedic providers,” he said. “We reserved portions of physical therapy schedules on a daily basis that would allow only this visit type to be scheduled. In essence, we provided our orthopedic team with exclusive physical therapy appointment availability as way of offering more timely options for their patients with a referral to physical therapy.”

The unique visit type launched on June 1, 2020. Its impact was immediate.

Appointment lag time decreased on average by 3.08 days, a 32% improvement. Patient satisfaction soared to 90.3%, a 16.1% increase.

But the overall bottom line lies with the referred patients. “Their outcome improves with timely care,” Parker said.

Parker submitted his project in Riverside’s Shared Solutions Program which is an annual program that provides Riverside team members with the opportunity to share innovative projects that are making improvements in the delivery of health care at Riverside.

The collaborative innovation puts Riverside in a better position to fulfill its mission of caring for others as we all would for those we love the most.