Introduction: Mounting health care costs and pressure from insurance companies and the federal government have led to a growing need to reduce excess medical expenditures. Subdural hematomas are an increasingly large proportion of neurosurgical consults, with an associated high rate of imaging and clinic visits. Efforts to reduce these clinic visits may help to slow rising health care costs and decrease redundant follow-ups.
Methods: From February 2007 to May 2012, 341 follow-up clinic visits for patients with traumatic subdural hematomas presenting to Indiana University Health Methodist Hospital in Indianapolis were retrospectively reviewed for imaging use, return to clinic visits, and costs.
Results: At the initial follow-up visit, 312 patients had resolved, improved, or stable head CTs and 27 had worsened or evolving hematomas. Patients were discharged without further follow-up in 268 cases, ordered to return to clinic with a new head CT in 68 cases, and underwent a revision surgery in one case, an asymptomatic patient with increasing hematoma. Of those 68 ordered to return to clinic, 38 patients had one additional follow up visit before discharge, seven had two more visits, and two had three visits after the initial follow up, with the remainder not returning. Only one of these required a surgery, at the time of his first return to clinic. Each nurse practitioner clinic visit had an average billing of $105 USD and a national average billing of $370-$1200 USD for each head CT.
Conclusions: In the overwhelming majority of cases, follow-up clinic visits and imaging studies performed routinely in an outpatient setting for traumatic subdural hematoma have significant health care costs and do not directly influence further surgical or medical management.
Patient Care: This research will reduce individual costs and provide increased convenience of follow-up for patients, with less frequent clinic visits and shortened appointment lengths.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Identify practical methods for reducing excess imaging and redundant follow-up appointments, 2) Discuss alternatives to formal follow-up that would save both patient and surgeon time, 3) Describe additional ways to streamline postoperative and post-inpatient care