Orthopaedic Care During the COVID-19 Crisis: Clinical Options Instead of the ER
Although the COVID-19 crisis and resulting “shelter-in-place” orders have led to a significant reduction in work and recreational activities, patients still sustain orthopaedic injuries and require musculoskeletal care. Currently, most orthopaedic offices have reduced the number of patients they will see. Some patients may be unable to obtain timely orthopaedic treatment because their injury or condition may not be deemed urgent enough. This leaves many patients with the option of either going to a local emergency room (ER) or avoiding care altogether, which can result in potential long-term complications.
While emergency physicians are able to evaluate and treat orthopaedic conditions, options other than an ER visit may be more appealing. Long waits are often the norm in ERs due to the wide spectrum of medical conditions that need to be seen. In addition, patients who have symptoms consistent with a COVID-19 infection frequently come to the ER for initial treatment. This puts other patients at risk for exposure to the virus, a concern for older and at-risk patients. From an economic standpoint, most ER visits are more costly than other medical venues. Many commercial insurers require higher co-pays for an ER visit as a way to discourage patients unless they have a true medical emergency.
Because of the drawbacks of emergency room care, urgent care clinics and orthopaedic injury clinics have become a valuable resource. They can serve the needs of patients with acute orthopaedic injuries or conditions that do not necessarily require more extensive care. Urgent care clinics are typically staffed by primary care physicians, physician assistants, or nurse practitioners. These providers are able to evaluate and treat the most common medical conditions seen in an ambulatory setting. But while the wait is not long and the visit is likely the least expensive, urgent care clinics do not have orthopaedic specialists. Therefore, a visit to an urgent care facility may result in symptomatic treatment and then referral to an orthopaedic surgeon for definitive care. Unfortunately, an expedient referral may not always be possible given the restrictions imposed by the COVID-19 crisis.
The orthopaedic injury clinic (OIC) is another model that has recently gained popularity. An OIC is typically part of an orthopaedic practice. It is designed to provide immediate care, similar to an urgent care facility. The advantage of an OIC over an urgent care clinic or ER is that it is solely dedicated to musculoskeletal care. This improves the overall quality of care because of the expertise of the staff and availability of specialized imaging (i.e., x-rays).
Compared with an ER, an OIC provides direct access to expert care, costs less, and has shorter wait times. An OIC can also facilitate more specialized follow-up with the clinic’s orthopaedic subspecialists when necessary. Perhaps the most relevant benefit of an OIC during the COVID-19 crisis is that it meets patients’ urgent orthopaedic needs while offloading emergency departments. This allows ERs to conserve vital resources needed to treat COVID-19 patients. It also reduces the unnecessary risk for orthopaedic patients of viral exposure from sicker ER patients. An OIC may offer “walk-in” service or on-demand appointments. Advantages of on-demand appointments are the opportunity to screen patients for COVID-19 exposure/symptoms and the ability to distribute patient appointments more evenly throughout the day in support of social distancing efforts.
In conclusion, patients with acute orthopaedic needs have other options than visiting the ER. It is important for patients to consider these other clinical models. They can receive timely, cost-effective orthopaedic care without the hazards, expense and wait times associated with an ER visit. Our goal is to encourage appropriate orthopaedic treatment while allowing ERs to treat true emergencies.
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AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.