When James Ficke joined Johns Hopkins a year and a half ago as director of orthopaedic surgery, patients with orthopaedic issues might have had to wait weeks to get in to see a specialist. Some likely went to other physicians or wound up in the Emergency Department, he says.

Now things have changed. In addition to efforts Ficke has led within the department to open access, the Depart­ment of Orthopaedic Surgery is one of the first to have signed on for a new Johns Hopkins program called Specialty Urgent Same-Day Response, or SUSDR. Through this initiative, patients with urgent orthopaedic issues who are enrolled in the Johns Hopkins Medicine Al­liance for Patients (JMAP), a Medi­care accountable care organization, can be referred to Johns Hopkins orthopaedic surgeons through a dedicated telephone line. Typically, they are then seen within a couple of days, with an appointment in one day as the goal.

Department representatives have seen a range of conditions, Ficke says, including sports-related knee injuries, urgent hand injuries, spine issues, and foot and ankle problems. Every physician assistant, nurse practitioner and surgeon on staff now keeps a timeslot open during each clinic for SUSDR referrals at all Johns Hopkins locations.

“We have definitely opened space to be able to see these patients,” he says. “It’s uniformly been positive.” Some 70 percent of issues that drive patients to emergency departments are musculoskeletal in nature, Ficke says. “We want to capture that and be able to support our patients here.”

The departments of Ophthalmology and Urology also have been participating in the SUSDR initiative. The divisions of Gastroenterology and Hepatology, and the departments of Surgery, Dermatology, and Otolaryngology–Head and Neck Surgery go live July 1.

Phone calls are triaged by a registered nurse, who confirms the urgent nature of the patient complaint and notifies the specialty department, which then contacts the patient to schedule an appointment. The SUSDR line then follows up with referring physicians to confirm that an urgent appointment has been scheduled, and specialists complete clinical documentation within seven days. For now, the service is primarily for JMAP patients, with some departments accepting additional patients.

The idea, says internist John Flynn, vice president of the Office of Johns Hopkins Physicians and executive director of the Clinical Practice Association, is to refer patients to SUSDR rather than wait until the patient has an emergency that requires an ED visit, driving up medical costs. “We’re working as a health system to provide the right care at the right time and prevent unnecessary escalation.” The fact that the departments are listening and signing on, he says, “is a result of many clinical leaders like Dr. Ficke bringing about a remarkable change in our culture.