“Best Advice for Treating Most Orthopedic Injuries: Avoid ERs.”
For effective treatment of most orthopedic injuries: avoid hospital emergency rooms. That’s the advice of noted, Florida-based orthopedic surgeon Alejandro Badia MD, who says finding a better option to the ER is especially important now as hospitals await a surge of emergency patients potentially infected by the new coronavirus – COVID-19.
Amidst doom-and-gloom newspaper headlines about overwhelmed emergency department staff having to respond to patients who seek testing for COVID-19, Dr. Badia is advising those with suspected bone fractures or ligament injuries, and especially strains, sprains, muscle pulls, to circumvent hospitals entirely and contact single-specialty orthopedic centers.
“Not only can these centers provide higher-quality and lower-cost care for most common bone and joint injuries, but they are much safer options than hospital emergency waiting rooms filled with coughing and sneezing patients who may have infectious diseases, including coronavirus and influenza,” says Dr. Badia, a specialist in treating musculoskeletal disorders of the hand, wrists and other upper limbs.
“Too often, patients with musculoskeletal injuries and disorders are sent by their primary physician – or go on their own – to a hospital emergency room where they wait for interminable lengths of time, are exposed to patients with infectious disease and undergo a battery of unnecessary diagnostic tests. Many of these same patients are ultimately referred to an orthopedic specialist for treatment anyway,” says Dr. Badia.
The orthopedic specialist is able to make a diagnosis of a musculoskeletal problem much more quickly than an emergency or general physician, with superior resolution of the clinical problem and at much lower cost, using less testing and fewer imaging studies, Dr. Badia states.
Evidence supports his comments.
A recent report from Deloitte, one of the world’s largest accounting firms, indicates that “markets with a higher concentration of urgent care centers have lower ER visitation rates,” which is in line with the goal of the nation’s Affordable Care Act to reduce “inappropriate utilization of ERs.” A 2019 Becker’s Hospital Review publication notes that emergency room charges rose an average 135 percent between 2008 and 2017.
Emergence of COVID-19 is only the latest hiccup for hospital emergency departments, many of which have been plagued for years by inefficient methods and processes for treating patients and moving them through the system, along with the growing dependence of primary care physicians on ERs as a referral source for their patients.
Even more troubling to Dr. Badia, however, are the missed and misdiagnoses, particularly when it comes to musculoskeletal problems.
Fractures in children are of particular concern to Dr. Badia. A study by University of Maryland School of Medicine researchers found that splints were placed improperly in 93% of suspected pediatric fractures treated in emergency rooms and/or general urgent care centers.
A study presented at the 2016 annual meeting of the Society of Military Orthopaedic Surgeons determined that a “significant number” of orthopedic conditions seen at some Level I trauma centers are “misdiagnosed and ineffectively managed,” with 78% of adult orthopedic consults were inaccurate,” study authors said.
Dr. Badia also points to a study published in the Journal of Orthopaedics showing that post-surgical infection rates tend to be significantly lower in single-specialty orthopedic centers than at multi-specialty facilities. Lower surgical-site infection rates are a measure of higher quality care.
Of the estimated 136.3 million emergency room visits annually in the United States, 40.2 million are for treatment of injuries, according to Becker’s Hospital Review. The National Center for Health Statistics attributes at least 5.6 million of these yearly injuries to children and young adults who play sports.
“Most sports-related injuries to joints, muscles, tendons and ligaments are more effectively and efficiently addressed by single-specialty orthopedic centers of excellence rather than by emergency medicine physicians in the ERs,” says Dr. Badia, who is founder and medical director of the Badia Hand to Shoulder Center and OrthoNOW®. OrthoNOW®, an orthopedic immediate care operation with licensees.
Of course, more serious, potentially life- or limb-threatening injuries may mandate a trip to the hospital. Dr. Badia offers these tips to help patients make good care decisions:
Contact an orthopedic clinic to treat sprains, muscle and tendon pulls, ligament tears, joint pain, joint dysfunction, and most bone fractures, including closed, displaced and non-displaced fractures.
Go to the ER for traumatic head and brain injuries, facial trauma, open fractures (bone protruding through skin), neurovascular injuries, nerve trauma, excessive bleeding.
Alejandro Badia, MD, FACS, internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW®, a walk-in orthopedic care clinic. He is a member of the American Society for Surgery of the Hand, American Association for Hand Surgery and the American Academy of Orthopedic Surgeons and an honorary member of many international professional hand societies. Dr. Badia specializes in treating all problems related to the hand and upper extremities, including trauma, sports injury, joint reconstruction, nerve injuries and arthroscopic surgeries. http://www.drbadia.com and http://www.orthonowcare.com