What is orthopaedic triage? A systematic review

Abstract

Rationale, aims and objectivesComplex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often described as ‘triage’ services. This paper reviews the literature pertaining to definitions and descriptions of orthopaedic/musculoskeletal triage processes, in order to provide information on ‘best practice’ to assist health care facilities.MethodA comprehensive open-ended search was conducted using electronic databases to identify studies describing models of triage clinics for patients with a musculoskeletal/orthopaedic complaint, who have been referred to hospital outpatient clinics for a surgical consultation. Studies were critically appraised using the McMaster quality appraisal tool and ranked using the National Health and Medical Research Council hierarchy of evidence. A thematic analysis of the definitions, processes and procedures of triage described within the literature was undertaken.Results1930 studies were identified and 45 were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from I to IV; however, the majority were at low levels of evidence and scored poorly on the critical appraisal tool. Three broad themes of triage were identified: presence of a referral, configuration of the triage (who, how and where) and the aim of triage. However, there were significant inconsistencies across these themes.ConclusionsThis systematic review highlighted the need for standardization of the definition of triage, the procedures of assessment and management and measures of outcome used in orthopaedic/musculoskeletal triage to ensure best-practice processes, procedures and outcomes for triage clinics.

An evaluation of diagnostic agreement rates between advanced practice physiotherapists and paediatric orthopaedic consultants for children with musculoskeletal complaints

“…Paediatric orthopaedics is an under‐resourced speciality (Health Service Executive, ; Hosseinzadeh, Copley, Ruch‐Ross, Schwend, & Sawyer, ), leading to excessive waiting times for patients and disenfranchisement by the public with outpatient services. Orthopaedic triage utilizes a screening approach to identify the most appropriate care pathway for patients, thereby reducing waiting times for patients (Morris, James, Davey, & Waddington, ). Recommendations are that orthopaedic triage clinics should be staffed predominantly by physiotherapists, with auxiliary support from the consultant team (Joseph, Morrissey, Abdur‐Rahman, Hussenbux, & Barton, ).…”

“…As APPs are often responsible for a patient's complete episode of care, it is essential that they demonstrate excellent clinical reasoning and diagnostic skills. The wide variability in the triage role, both from centre to centre and within national healthcare systems, has been consistently identified (Desmeules et al, ; Joseph et al, ; Morris et al, ; Oakley & Shacklady, ; Saxon, Gray, & Oprescu, ), thus necessitating research to be completed within individual systems (Stanhope, Grimmer‐Somers, Milanese, Kumar, & Morris, ).…”

A service evaluation of e-triage in the osteoporosis outpatient clinic—an effective tool to improve patient access?

“…The traditional approach of direct face-to-face clinical encounters is challenging with increasing referral volumes to osteoporosis services. Electronic active triage offers an opportunity to address extensive waiting times for access to medical services through a streamlined screening process [9]. Examples of triage exist within a range of high volume referral specialties including orthopaedics, dermatology and in neurological services [4,9,10].…”

Advanced musculoskeletal physiotherapy practice in Ireland: A National Survey

“…and C.C.] and informed by stakeholder consultation and current APP literature (Griffiths, Taylor, & Yohannes, ; Morris, James, Davey, & Waddington, ; Saxon, Gray, & Oprescu, ; Syme, Rutter, Suckley, Payne, & Russell, ), with minor amendments made following a pilot study with three APPs. Thirty‐two questions, including a variety of closed multiple‐response option and open‐ended questions, explored: (a) APP triage service characteristics; (b) clinician qualifications and practice characteristics; (c) clinician experience (positives and challenging aspects) of the advanced practice role; and (d) patient outcome data (i.e., 2011 and 2016 wait times, and PROMs collected and deemed important).…”