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How Clinic Design Cut Orthopedic Wait Times From A Year To Three Weeks In Travis County

Gabriel Cristóver Pérez
Maria Tappan, staff educator at Dell Seton Medical Center, points to the Dell Medical School campus during a tour of the new Dell Seton Medical Center.

It used to take more than a year for low-income people in Travis County to get in to see an orthopedic, or skeletal, specialist. However, thanks to a new approach and a clinic run by Dell Medical School at UT Austin, that wait time is now about three weeks.

The reason for this is a team of half a dozen doctors, nurse practitioners and research assistants.

Every Monday and Thursday morning they meet in the basement level of the Clinical Education Center at Brackenridge and huddle around a computer. In about half an hour, patients will start trickling in, but first the team takes time to talk about each one.

This is called an “integrated practice unit.” It’s part of Dell Medical School’s mission to innovate the way health care is delivered. This orthopedic team works together closely to provide care.

They don’t just tackle orthopedic problems, either. As they discuss one patient facing knee issues, Dr. Karl Koenig, the team’s leader, brings up mental health.

“I think we have to acknowledge the fact that she has several psychiatric diagnoses,” he tells the team. “So a lot of patients with severe patella femoral issues do tend to have depression and other things – and we don’t know why medically those things run together, but anything we might do to fix this problem has to take those other things into context.”

The team sees roughly 20 to 25 patients during each clinic. And Koenig says each of those visits takes longer than most orthopedic consultations because it’s more comprehensive.

“If they decide they want to do a physical therapy program, then we are actually teaching them that physical therapy program,” he says. “And trying to get them so that they can do those things at home. If they are having other issues with emotional stress in their life, then we are trying to engage on that. And, so it’s a very different way of practicing.”

It may seem counterintuitive, but these longer visits actually kept wait times down. Koenig says this approach leads to fewer follow-up appointments because patients are getting all the care they need.

The clinic also keeps a lot of data to make sure the treatments it is using have consistently good outcomes, which also keeps follow-up numbers low. And then there’s communication.

“We try to open up lines of communication both online and by phone, to say, ‘If this isn’t working for, you call back, we will bring you in again,’” Koenig says. “But if you don’t book everybody for a follow-up appointment, then you open up more slots to see more people.”

When the team started this project, Koenig says it sifted through a really long waiting list kept by the county’s health care district, which serves the area’s indigent population. He says that system wasn’t working. And even though there’s still room for improvement, he says, this new system has made getting orthopedic care in Travis County a whole lot easier. 

Ashley Lopez covers politics and health care. Got a tip? Email her at Follow her on Twitter @AshLopezRadio.
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