Building a Local Care Team After Returning Home

A Contact List Is Not a Care Team

A local care team exists only when named clinicians have reviewed the operation and current plan, accepted defined responsibilities, can communicate with the operating center, and have an emergency pathway. CDC recommends coordinating local follow-up before medical travel and planning complication care with both clinicians. ^[1]

Roles to Assign

• Local orthopedic clinician: examination, urgent triage, imaging review, and defined management or referral responsibilities.
• Physical therapist: repeatable motion and function measures, prescribed exercises, load compliance, and escalation.
• Radiology site: required views, positioning, calibration, DICOM delivery, and timely reports.
• Local prescriber or pharmacist: legal medication continuity, interactions, monitoring, and controlled-substance limits.
• Emergency and revision facility: neurovascular, VTE, infection, fracture, compartment, implant, and surgical capability.
• Operating center: named clinician with authority for distraction, loading, device, and return-to-center decisions.

Co-Management Is Not Blind Protocol Compliance

A local licensed clinician must use independent clinical judgment and cannot be asked merely to follow an overseas instruction that appears unsafe. The handoff should define decision ownership, disagreement escalation, and access to the operative surgeon. Respectful two-way communication is safer than treating either team as a messenger.

Handoff Packet

• Operation and discharge reports, implant card, allergies, medications, complications, and recent examination.
• Current images and required future views, positioning, cadence, and secure transfer route.
• Written distraction, loading, therapy, wound, VTE, emergency, and removal plans.
• Individual motion and function thresholds, not generic examples copied from another patient.
• Routine, urgent, and emergency response times and after-hours contacts.

Therapy Must Be Measured and Bounded

The therapist should know the current bone and implant status, load restriction, prohibited movements, individual targets, and stop rules. More aggressive is not inherently better, and pain or nerve symptoms should not automatically be pushed through. Report measurable change to the responsible clinician.

Image Consistency Matters

The operating team should specify views and positioning. DICOM preserves diagnostic and technical information that a compressed image can lose. Record who reviewed each study, when, the interpretation, and any resulting order.

Test the Handoff Before Leaving

Complete one local appointment, imaging transfer, clinician-to-clinician contact, therapy measurement, prescription plan, and after-hours test before travel. A provider who has not accepted the case should not be counted as contingency coverage.

Emergency Care Does Not Wait for Overseas Approval

Chest symptoms, new major motor loss, circulation change, suspected compartment syndrome, uncontrolled bleeding, severe infection, fracture, or hardware failure goes to local emergency care. Contact the operating center in parallel when feasible, not instead of evaluation.