700 Section - Cross-Clinic Variability in Physiatry Workflow: A Comparative Analysis of Three Multinational Spasticity Practices

Objectives : Demand for spasticity management increases, while clinic capacity, staffing, and physical space remain constrained. Although spasticity techniques and outcomes are well described, the operational structures that shape access, throughput, and provider sustainability in outpatient settings are rarely examined. We compared workflow bottlenecks and efficiency strategies across outpatient spasticity clinics and identified approaches that were broadly transferable versus context-dependent.

Design: We conducted a comparative, multinational quality improvement study across three outpatient spasticity clinics representing distinct care models, including community-based academic, private practice, and academic hospital–based settings. Data sources included structured workflow observations, role mapping, clinic layout assessment, and semi-structured interviews with clinicians and staff. Comparative thematic analysis was used to identify shared operational constraints, divergent workflow models, and strategies to improve patient flow.

Results:

Across sites, clinics managed approximately 6–25 patients per session, with appointment durations ranging from 15–60 minutes depending on visit type and complexity. Despite differences in organizational structure and resources, common bottlenecks included room turnover delays, staffing variability, and supply-related and scheduling disruptions related to teaching responsibilities, and administrative processes. Transferable strategies included standardized injection kits and supply carts, pre-session room allocation, team huddles, and use of advanced practice providers for intake and routine follow-up. Context-specific strategies included pod-based room design, signaling systems, and dedicated navigator roles. Attempts to restrict patients to specific clinic days were consistently ineffective due to variability in patient complexity. Clinicians emphasized that efficiency is limited not only by workflow speed but by need to define clinic scope and prioritize patients requiring specialized expertise.

Conclusion:

Operational efficiency is a core component of high-quality spasticity care, directly affecting patient access, provider workload, and long-term clinic sustainability. Making implicit workflow knowledge explicit through standardized processes, role clarity, and intentional clinic design may help physiatrists improve throughput, reduce burnout, and expand access to specialized spasticity management within real-world constraints.