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Table 5: Percentage of Surgeries that were Day Cases, SUL, 2016

% DAY
TYPE OF CASES
SURGERY
Shoulder 75%
Elbow 59%

Wrist/Hand 70%

Overall in 2016, including urgent and elective cases, 69% of SUL cases were day surgery patients and
31% were inpatient cases.

EC Objective 3: Appropriate Utilization of Diagnostic Services

One of the major drivers of costs in health care is the inappropriate over-utilization of certain diagnostic services. One of the costliest diagnostic
service is magnetic resonance imaging (MRI). Overuse of medical interventions such as the MRI is a widespread problem, leading to excess costs
10
and sometimes adverse outcomes. Overuse is driven by many factors, including patient expectations and a lack of appropriate guidelines. MRIs
are also expensive, take time out of patients’ schedules and can be stressful.

At the same time, diagnostic imaging such as the MRI offer an essential diagnostic tool for many injuries and conditions and represent the only
viable test for certain diagnoses, especially in Orthopedics. For instance, MRI is a primary imaging technology for detecting failure in soft tissues,
such as meniscal, ligament and tendon tears, and in occult bone injuries. 11

SUL has guidelines for optimal utilization of the MRI and follows a clinical protocol to ensure its proper use by all its physicians. There are no
established benchmarks in the research literature, although 30% is a normative threshold that can be used. In keeping with the Unit’s goals to
12
practice conservative medicine, SUL has committed not to exceed 25% of eligible clinic patients receiving MRIs.

10 Emery DJ, et. al, Overuse of magnetic resonance imaging, JAMA Internal Med. P. online Mar.25 ’13.
11 Crues J, Bydder G, Frontiers in musculoskeletal imaging. J Magn Reson Imaging. 2007 Feb; 25(2):232-3.
12 25% of only half of the overall clinic numbers, which represents patients eligible for an MRI (the other ½ could be follow ups, post-op routine visits, etc.)
The Shoulder and Upper Limb Unit