Dr. Kishore Mulpuri
Dr. Emily Schaeffer, Dr. Lydia Bajno, Wendy Krishnaswamy, Carolyn Beaton, Penny Thiessen, Roya Yamini
Developmental dysplasia of the hip (DDH) is the most common pediatric hip condition and is a major cause of hip replacement or osteoarthritis in young adults. Due to potential impact on quality of life, every child is checked at birth for unstable hips. Should instability be detected, or the infant has other DDH risk factors, they are referred for an ultrasound exam and orthopaedic surgeon consultation.
Since the implementation of a DDH screening program at our institution, the Radiology Department has seen a dramatic increase in hip ultrasounds performed. While helping prevent the complications of missed DDH diagnoses, this program has placed strain on radiology resources, and often families must attend multiple appointments before receiving a diagnosis and beginning treatment. To mitigate this, a pilot point-of-care DDH clinic was implemented, where an ultrasound technician performs hip ultrasound exams using a portable ultrasound in the orthopaedic clinic in conjunction with surgeon consultation. The aim of this clinic was to enable diagnosis and treatment in one appointment, reduce referral-to-treatment delays, wait times, and decrease costs and travel time for families while also alleviating strain on radiology resources.
To date, 84 patients have attended the pilot clinic. Families spent an average 104.1 minutes (range 10 minutes – 1080 minutes) traveling to the hospital for an appointment (208.2 minutes round-trip). This program reduced the number of hospital visits for DDH screening from three to one per patient, saving an average 416.4 minutes of travel time to/from the hospital per family. Appointment time averaged 43.0 minutes and families rated their satisfaction with appointment length an average of 9.7/10 (68/84 families rated satisfaction 10/10, 1 = very unsatisfied, 10 = very satisfied). Additionally, 79/84 families were also asked to rate their satisfaction with check-in/check-out processes (average 9.3/10), ultrasound screening (average 9.9/10), and time with specialist (average 9.7/10). Satisfaction scores did not differ based on variables such as survey taker’s gender, occupation, or geographic location. Many families also commented on how much they appreciated being able to have the entire check up done in one appointment. “As we traveled in from Chilliwack, this process of seeing the specialist in the ultrasound room was very convenient.”