Navy SMART clinics

[militaryPHYS]

Any Navy providers have experience with their local Sports Medicine and Rehabilitation Team (SMART) clinics?

Currently we are optimizing ours locally to become tri-service and have all MSK care funneled through there to ensure early establishment in an MSK care pathway and early diagnosis/dispo to prevent delays in care. No consult needed. Daily walk in clinic. No preceding PCM/GMO visit required.

Army has a similar system (SPARTA clinic).

It is the right idea but there is huge variance in how well it is run based on duty location.

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[pgg]

Any Navy providers have experience with their local Sports Medicine and Rehabilitation Team (SMART) clinics?

Currently we are optimizing ours locally to become tri-service and have all MSK care funneled through there to ensure early establishment in an MSK care pathway and early diagnosis/dispo to prevent delays in care. No consult needed. Daily walk in clinic. No preceding PCM/GMO visit required.

Army has a similar system (SPARTA clinic).

It is the right idea but there is huge variance in how well it is run based on duty location.

Sounds awesome.

As a Marine GMO I turfed a fair amount of my musculoskeletal sick call to the Lejeune sports medicine clinic. Not sure if it was called a SMART clinic in those days (2003-2006). As a post-TY-intern GMO bound for not-orthopedics, quick referral seemed like the right thing to do for the non-trivial stuff. They gave me a fair ration of **** about it, more than one accusation of dumping sick call on them, but I didn't really care. Hopefully today's SMART clinics are a little friendlier to referring GMOs.

 

[Cooperd0g]

I don’t have a local SMART clinic ...

 

[militaryPHYS]

Have you in the past? Just trying to get feedback on effectiveness of different locations.

 

[DrMetal]

I can vouch for the SMART clinic in San Diego (32ndSt NAVSTA), used them extensively when I was a ship's GMO, they were great.

I don't know about the 'No Consult' thingy. It would be good for the primary care physician (ie the GMO or SMO) to know what's going on, to have to place the consult, to ensure its really needed. Otherwise every seaman timmy with a sprained ankle is going to crash the clinic trying to get out of work.

 

[Cooperd0g]

Have you in the past? Just trying to get feedback on effectiveness of different locations.

My only personal experiences with SMART clinics were in specialized locations (basic, academy) so they were definitely not open to people outside those commands.

 

[TheTruckGuy]

I like them. My MSK skills are pretty good, but my approach to rehab exercises tends to be more of a shotgun approach than a very targetted one. No where near what a PT/sports med doc could do. Also, without an ultrasound my ability to look for certain injuries is limited, as well as my ability to try certain diagnostic injections that require a little more precision.

I hate turfing patients away, but I feel that some of them also feel like they're getting better care from the SMART clinic because it's a "specialist" and not just a regular GMO looking at them.

A couple things I've noticed though - in the Air Force, anyone can self refer to physical therapy at any time for any MSK injury. We can't do that in the Navy, so the SMART clinics are a good alternative. But they vary in their acceptance policies. I've seen 14, 30, and 90 day injuries limitations for walkins.

Patients do seem to love having a chiropractor available.

In regards to Seaman Timmy trying to go in for a LD chit for a barely rolled ankle, as annoying as it is for PCMs, I think it's appropriate for SMART clinics to not give LD chits at all, or for only a day or two, unless there's an obvious serious injury.

I also think periodic CME type events run by the SMART clinics to help providers know when to refer to PT vs OT vs chiro vs podiatry vs ortho vs just treating conservatively without anything would be good. However GMOs are lazy and usually don't care enough to go to these, would rather just refer blindly to PT and the SMART clinic, maye ortho as well, and just tell the patient to go to whichever they can get into first, as well as order an unnecessary MRI (have seen this happen many times).

 

[militaryPHYS]

You hit everything right on the head in terms of same issues we are dealing with. The concept is good but there are such inconsistencies based on location that we all have to reinvent the wheel at every new duty station.

I’m trying to take the decision process out of the equation because that is where things fall through the cracks based on who is making the decision (IDC vs. GMO vs. PCM, etc). Any new MSK injury (under 90 days) should not even see GMO, IDC or PCM and report straight to SMART clinic. SMART clinic staff is seamlessly integrated with sports med, PT, chiro and ortho so that as long as patient gets to SMART clinic the most appropriate plan of care can begin. That includes Initiation of non-op rehab (PT), INDICATED ASAP MRIs, early eyes on by ortho if required, etc etc.

One visit saves the patient, providers and consultants time, access to care and headaches. It starts the warfighters return to full duty on day 1 or 2 of their injury.

 

[militaryPHYS]

Or every unit has MSK asset integration (ATc, PT) that is also seamlessly integrated in the MSK working group so you negate the need for SMART clinics and you have well established tiers of care. Unit level ATc overseen by sports med docs who are in direct communication with PT and Ortho to start care pathway day 1 of injury.

Unit level integration OR regional SMART clinics. USMC and USN just can’t decide what they want. Regardless, leave the GMO and PCM out of it and let them focus on the other areas they need to focus on to keep the units and warfighters ready to fight.

 

[DrMetal]

- in the Air Force, anyone can self refer to physical therapy at any time for any MSK injury.

A terrible idea, but typical of the chair force. Is this really true? So Airman Timmy can self refer for a mild ankle sprain, and excuse himself from work to go to PT 3 times/week x 4 weeks?

 

[TheTruckGuy]

A terrible idea, but typical of the chair force. Is this really true? So Airman Timmy can self refer for a mild ankle sprain, and excuse himself from work to go to PT 3 times/week x 4 weeks?

I had heard about it previously, but saw it for myself when our unit went to an Air Force base for a det last year - Active-duty Airmen to have direct access to physical therapy clinics

Here's the thing. Seaman/Airman Timmy is going to try getting out of work however he can. If he can't go to his PCM, he'll go to PT, or even try the ER. You won't believe the crap that walks through the doors of military ERs. At least if he goes direct to PT/Sports med, someone that understands the ankle mechanics better, can tell it's just a mild sprain, etc., can tell he's full of crap and give him some exercises and tell him to f/u with his PCM. If it's a legit sprain that requires some taping or a brace for a while, and continued PT, the SMART clinic can set him up for that further down the line.

Just because someone self-refers to PT doesn't mean the PT is obligated to see them beyond an initial eval.