Maximizing use of a surgical clinic for referrals of patients having back problems

OBJECTIVE: To determine ways to improve the delivery of service in a surgic al clinic, based on the outcome of surgical consultations for back pain. DESIGN: A prospective outcome study. SETTING: A university teaching hospital providing secondary and tertiary ca re. PATIENTS: One hundred and forty-two consecutive patients who presented to s urgical clinics for assessment of a back problem between Apr. 14 and May 30 , 1996. INTERVENTIONS: Surgeons determined the diagnosis and visit outcome; data we re tabulated objectively by a third-party researcher. OUTCOME MEASURES: Waiting time for consultation, presence of referral lette r, third-party interests, diagnosis and visit outcome. RESULTS: Twenty-five percent of patients had chronic pain not amenable to s urgery, 19% of patients were surgical candidates and were offered an operat ion, 13% were symptomatically improved to the point of not wanting an opera tion, 11% wanted a second opinion only, 10% had mechanical back pain approp riate for referral to physiotherapy, 9% had not undergone an adequate trial of nonoperative treatment when seen in the clinic and were given follow-up appointments, 5% were "no shows," 3.5% were seen for a medicolegal assessm ent, 3.5% wanted confirmation from a specialist that they did not need surg ery and 1% had symptoms due to a vascular rather than a spinal cause and we re referred to a vascular surgeon. CONCLUSION: Delivery of service could be improved by more rigorous screenin g to reassign appointment times of patients who have not had an adequate tr ial of nonoperative treatment, are improved or do not intend to keep their appointment.