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 surgical 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 care. PATIENTS: One hundred and forty-two consecutive patients who presented to surgical clinics for assessment of a back problem between Apr. 14 and May 30, 1996. INTERVENTIONS: Surgeons determined the diagnosis and visit outcome; data were tabulated objectively by a third-party researcher. OUTCOME MEASURES: Waiting time for consultation, presence of referral letter, third-party interests, diagnosis and visit outcome. RESULTS: Twenty-five percent of patients had chronic pain not amenable to surgery, 19% of patients were surgical candidates and were offered an operation, 13% were symptomatically improved to the point of not wanting an operation, 11% wanted a second opinion only, 10% had mechanical back pain appropriate 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 assessment, 3.5% wanted confirmation from a specialist that they did not need surgery and 1% had symptoms due to a vascular rather than a spinal cause and were referred to a vascular surgeon. CONCLUSION: Delivery of service could be improved by more rigorous screening to reassign appointment times of patients who have not had an adequate trial of nonoperative treatment, are improved or do not intend to keep their appointment.