When patients don’t show up for their scheduled surgery, many costs are incurred that cannot be recouped, including the OR staff, the anesthesiology team, and equipment and medication that have been ordered. Reducing potential “no-shows” is imperative to maximize efficiencies. In addition to “no-shows,” reasons for cancelled surgeries to include scheduling errors, equipment problems, cancellations due to patient medical status, and emergency surgeries bumping medical procedures.
Key predictors of no-shows include prior missed appointments, history of alcoholism or other substance abuse and/or psychiatric issues. Measures can be taken to deter no-shows among patients from low-income background, such as scheduling appointments around public transportation times, educating patients on the benefits of the surgery, and eliminating the fear of uncomfortable procedures that seems to be higher in low-income patients.
On December 4, in association with the Journal of Orthopaedic & Sports Physical Therapy, JBJS hosted a complimentary webinar, “Adhesive Capsulitis/Frozen Shoulder.” The webinar presented a unique, dual perspective on managing frozen shoulder and examined how these two disciplines can work together for the best patient outcomes. Moderated by Andrew Green, MD, the webinar reviewed the following recently published articles, which were presented by authors George Murrell, MD, and Martin J. Kelley, DPT:
• Long-Term Outcomes After Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis. J Bone Joint Surg Am. 2012 Jul 3;94(13):1208-16. doi: 10.2106/JBJS.J.00952
• Clinical Practice Guidelines: Shoulder Pain and Mobility Deficits: Adhesive Capsulitis. J Orthop Sports Phys Ther. 2013 May;43(5):A1-31. doi:10.2519/jospt.2013.0302
Commentary was provided by Jo Hannafin, MD, PhD, and Philip McClure, PT, PhD.
Below are some of the highlights from this interactive webinar.
6 important treatment methods to consider:
- Release of anterior, posterior, and inferior capsule
- Use of perioperative intra-articular steroids
- Early postoperative physical therapy
- The reasonable postoperative goal should be patient satisfaction and functional range of motion, not necessarily full range of motion
- Pain and muscle guarding can lead to a patient losing half of his or her range of motion on the 1st post-operative day
- Don’t push a patient going through physical therapy to a range of motion beyond that which was achieved immediately post procedure
One of the questions from the Q & A portion of the webinar:
Q (audience): Are there rheumatoid or inflammatory markers or factors that have been associated with any of the phases of adhesive capsulitis/frozen shoulder?
A (Jo Hannafin, MD, PhD): No there haven’t. There have been cellular responses that would intimate that you had an inflammatory factor. One of the things that causes the contraction of the capsule is an increase with myofibroblasts. Some years ago, there was a demonstrated increase of TGF-beta staining in the capsule as well as connective-tissue growth factor. It has never been measured in synovial fluid, but you can see the staining in the perivascular region of the capsule.
This complimentary webinar was recorded and is now available on-demand: http://bit.jbjs.org/IHPY2n