Efficiency Benefits of Live Fluoroscopy in Hand Clinics.

Background: Postoperative imaging protocols for common hand procedures typically consist of 2-3 plain radiographs at defined intervals dependent on the surgery. Radiographs typically verify reduction, hardware position, and/or evaluate for complications, but also generate costs and alterations in clinic flow. We hypothesize the use of mini-fluoroscopic images will provide comparable clinical data with less cost and improved clinic flow. The objectives of the study were to determine if clinic-based fluoroscopic imaging is feasible for post-operative hand patients and if fluoroscopic imaging results in improved clinic flow (less waiting and more time with provider) and theoretical cost savings using mini-fluoroscopy instead of traditional radiographs. Methods: With institutional review board exemption, the prospective use of mini-fluoroscopic evaluation of post-operative hand surgery patients was compared to traditional radiographs using time-based cohort analysis. Patients who underwent percutaneous pinning of phalanges/metacarpals, ORIF (open reduction and internal fixation) of phalanges/metacarpals or ORIF of distal radius fractures were included to evaluate common hand surgery patients. Each cohort consisted of a 3-month data collection period with prospective measures of clinic flow (wait times, appointment times, time with provider) and estimated cost compared between the groups. Results: 24 patients met inclusion criteria for data analysis; 11 patients in the mini-fluoroscopy group and 13 patients in the traditional radiograph group. Appointments using mini-fluoroscopy were 24 minutes shorter (53 vs 77 minutes) from patient check-in to check out time. Check-in time to rooming was 10 minutes quicker (9 vs. 19 minutes) using mini-fluoroscopy. Traditional hand radiographs have a face-value of $734 per appointment/series for a total theoretical savings of $9540 (n=13). Conclusion: The use of mini-fluoroscopy during orthopedic hand surgery post-operative visits provides a feasible, quick, cost effective way to evaluate patients postoperatively, ultimately, resulting in quicker patient appointments and greater time spent with providers. Level of Evidence: III.