Purpose
We sought to evaluate the use of pre- and post-referral advanced diagnostic testing
among patients with 3 common hand conditions, rates of subsequent tests, and differences
in wait time to see a hand surgeon.
Methods
We analyzed a single academic tertiary care center administrative database of encounters
from 2006 to 2015 to identify adult patients who were referred to a hand surgeon for
3 conditions (carpal tunnel syndrome [CTS], soft tissue masses [STM], and joint pain
[JP]). We recorded patient characteristics, use and timing of diagnostic tests, and
wait time for the initial hand surgeon evaluation.
Results
Among patients who received advanced diagnostic tests before the surgeon evaluation,
CTS patients had the highest rate of receiving pre-referral advanced testing (53.4%)
compared with JP (10.6% ) and STM patients (5.8%). The CTS patients had the highest
rates of repeat testing (19.5%) compared with patients with JP (1.4%) and STM (0%).
Across all 3 conditions, patients who received pre-referral advanced testing waited
an additional 19 to 94 days to see a surgeon, compared with patients who received
only post-referral testing or no testing.
Conclusions
Use of pre-referral advanced diagnostic tests is associated with an increased time
to see a hand surgeon for common hand conditions.
Clinical relevance
Hand surgeons should have a role in identifying patients who do or do not benefit
from advanced testing before referral to ensure that tests ordered before consultation
are useful to both patients and treating surgeons.
Key words
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Article info
Publication history
Published online: October 30, 2019
Accepted:
September 25,
2019
Received:
November 15,
2018
Footnotes
Ms Chung received funding from Chang Gung Memorial Hospital Project CORPG3G0111 and CORPG3G0161. Dr Chung was supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number 2 K24-AR053120-06, a Midcareer Investigator Award in Patient-Oriented Research. Dr Sears received funding from the American Foundation for Surgery of the Hand Clinical Research Grant under Award Number N022105, Career Development Award Number IK2 HX002592 from the US Department of Veterans Affairs Health Services R&D Service. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article. The funding organizations had no role in the design and conduct of the study, including collection, management, analysis, and interpretation of the data. The content is solely the responsibility of the authors and does not necessarily represent the official views of the United States government or Veterans Administration.
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© 2019 by the American Society for Surgery of the Hand. All rights reserved.
