Outpatient Amputee Clinics Can Eliminate Miscommunication Across the Provider Spectrum

RENO, Nev. — Outpatient amputee
clinics can reduce miscommunication among health care
providers, while maximizing efficiency and time management, according to Mike
Goodman, DO, physical medicine and rehabilitation physician, Physiatry
Associates Ltd. Goodman discussed creating and running an outpatient amputee
clinic at the 2011 Hanger Education Fair in Reno, Nev.

  Jamee Heelan
  Jamee Heelan

“The clinic concept can accomplish multiple appointments in a
15-minute visit,” Goodman said. “Instead of bouncing back and forth
and exchanging phone calls with multiple providers, the therapist, prosthetist
and physician are in the same room. We are all getting the same information
with the same background. It makes it easier to identify the problem and offer
a resolution.”

Team concept

At the Rehabilitation Institute in Chicago (RIC), the staff includes
rehabilitation physiatrists, an orthopedic surgeon, a prosthetist, a physical
therapist on call, as well as an occupational therapist. The clinic runs in
three or four different rooms within the facility and an appointment could last
15 to approximately 45 minutes. Ideally, the therapist who was initially caring
for the patient, will also be in the clinic, Goodman said. He also recommended
finding a physical therapist who is passionate and qualified to work with

“It’s hard to do, but they, along with the O&P
practitioners are really going to help drive the clinic,” Goodman said at
the meeting. They are an integral member of the team.”

When looking for a location for your clinic, one question that should be
asked is how convenient is it for the patient to park?

“Parking is a huge issue,” Goodman said. “Patients
generally can not get to the location if the parking lot is a mile away from
the building. The easier it is to get to your facility, the more likely it is
they will make it to their appointment.”

  © iStockphoto.com/Sean

Clinics can be conducted at a hospital or at one of the clinicians’
office as long as all of the necessary equipment is available. Does the office
have parallel bars? This is also a major concern according to Goodman.

“It stunned me that some physical therapy facilities still do not
have parallel bars for their patients,” he said.

The clinic experience

Jamee Heelan, OTR/L, education program manager, RIC, conducts an
educational outreach with the families prior to their visit, describing how the
clinic will operate, as well as the tools the clinic has and does not have.
Many times, an initial phone call will alleviate the patient anxieties,
according to Heelan. It also gives her the opportunity to send the patient
materials and literature so that he or she can have time to come up with any
questions for the clinical team.

“When they come to the clinic, they already have an understanding
of what the clinic is and what to expect,” Heelan told O&P Business
. “If they are nervous about the number of professionals in the
room, we would know about it ahead of time and ask certain members to leave the

At RIC, the evaluation will typically run 30 minutes to 1 hour prior to
the beginning of the clinic. The therapist — either physical or
occupational — will conduct an evaluation. The prosthetist is usually
invited to that evaluation as well.

Typically for a new patient at RIC, after the evaluation, the therapist
whom the patient is most familiar with will set up a meeting with the rest of
the team members. From there, the physician will evaluate the patient and
discuss his or her role in the clinic. If the patient is a child, RIC’s
rehabilitation physiatrist will ask the child questions pertaining to their
development as a person, unrelated to their prosthesis, such as how things are
going in school or whether or not they have been to therapy. The physiatrist
tends to take the view of the person as an individual, according to Heelan.
After the clinic, the patient, as well as the clinical team, will have a good
understanding of the patient’s next steps, whether it will be getting
refitted, making a new appointment or leaving with additional information.

“The best protocol for families is the team approach. As a
clinician, that is what I value the most. Having the team members here, you
build relationships with the physicians and the therapists. From the
patient’s perspective, he or she knows that they have a team to lean on as
opposed to just one individual,” Heelan said.

Create your own

If there are no outpatient amputee clinics in your area, Heelan
recommended creating your own. Goodman called it “filling the gap.”

“A clinic is really developing the communication skills and
creating a raport with other providers through the phone, email or face-to-face
meetings,” Heelan said. “The surgeon that is over at the other
hospital does not think twice about referring a patient to me because he knows
we have the resources.” — by Anthony Calabro


Historically, the prosthetic clinic model was how patients were managed.
Because of the many changes to our health care system, we got away from the
clinic approach when physical medicine became much more specialized.

What you are seeing today is that we are all talking with each other
through patient notes. In larger metropolitan areas, patients are going into
large systems that have the team approach as part of their continuum of care
which works well. It is much more efficient from a surgeon’s perspective,
to send the patient over to the physiatrist and have a qualified team do the
evaluation rather than performing the amputation and having the patient find
someone in the phonebook. It is not good for the patients. The patients are
demanding greater support, which is appropriate.

When you bring the disciplines together, you have experts from many
different areas that can address the many different problems that could arise.
It makes everyone involved better. If you have that one-stop shop, it helps
family members take less time off of work and they can still be part of the
decision making process.

— Martin Sean Ryan, LCP, FAAO
manager of clinical operations, ACTRA/O&P, Wisconsin Prosthetics and
Orthotics, Physiotherapy Associates

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