INCORPORATING HAND THERAPISTS INTO YOUR HAND SURGERY CLINIC

If you do not presently have hand therapists seeing patients with you full time in your hand surgery clinic, you should think about making that happen for at least a few hours per week. There are many advantages to this1:

1. 
   

   You can educate each other so you both enhance your skills.

   
   
2. 
   

   Verbal communication between you and the hand therapists will produce better patient outcomes in complex problems such as flexor tendon repair and reconstruction.

   
   
3. 
   

   The patient will see that you are a team and will want to become an active participant in your efforts to produce the optimal outcome.

   
   
4. 
   

   The patient will see that you value the therapist′s opinion and thus will be more likely to listen to the therapist and comply with instructions.

   
   
5. 
   

   In some systems such as ours, therapists can take over patient care from the surgeon and complete the care for many hand problems. This frees up the surgeon′s time, and the therapist can provide excellent ongoing one-on-one care.

   
   
6. 
   

   If you begin performing WALANT hand surgery in your clinic, therapists can watch the surgery and assess the patients. In addition, therapists can educate the patient between the time of local anesthetic injection and surgery, as well as during the surgery itself. Clip 15-1 shows hand therapists engaging in preoperative therapy consultation between injection of local anesthetic and surgery for a flexor tendon repair in a 10-year-old girl.

   
   
7. 
   

   Therapists will waste a lot less time and avoid making judgment errors based on inadequate information because they could not communicate with the surgeon.

   
   
8. 
   

   It will be easier for you to start doing early protected movement for finger fractures if the therapists see patients with you in the clinic (see Chapter 41).

HOW TO INTEGRATE HAND THERAPISTS INTO YOUR CLINICS AND WALANT PROCEDURES

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  The surgeon must initiate the effort to integrate therapists into the clinic—because no one else will do it. You can begin by making appointments with the hospital and therapy administrators to get this process started.

  
  
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  Arrange to talk to the key hospital administrators one at a time. Convince them that you need a hand therapist to come to your clinic for 1 hour once a week so you can see patients with complex hand conditions with him or her. You can schedule complex patients to arrive when the therapist is there so no time is wasted. We began this in our hospital 25 years ago. One hour became 2 hours; once a week became twice a week; one therapist became two therapists. We now have two or three therapists for 4 hours 3 days a week.

  
  
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  We perform our WALANT hand minor trauma procedures in the clinic in one room while the therapists are working in another clinic room where they make orthoses (splints) and see patients (see Chapter 16 for a video of our clinic setup). These are primarily hand fractures and tendon and nerve lacerations. Major hand trauma is still handled in the main operating room.

  
  
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  We ask the therapists to come into the clinic operating rooms to observe parts of procedures. They perform intraoperative patient assessment and education as required (see clips that follow) in between their splinting and consultation duties.

  
  
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  Point out anatomic structures to the therapists, much as you would do with a medical student or resident. Demonstrate how reconstructed tendons and bones move or function during the surgery.

  
  
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  Hand therapists will start to engage with the patient even before the surgery. Therapists can start patient education in the time after the local anesthetic injection while the surgeon is seeing other patients and waiting for the local anesthetic to take optimal effect. When they are familiar with your techniques, they can do a better job of educating your patients about what to expect after surgery. This will be even easier for them if they have seen you perform the surgery.

  
  
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  Do not forget that the hand therapist is in the room! Talk with the therapist about what you are seeing or doing. This will help him or her to determine the best postoperative care.