Musculoskeletal triage: a mixed methods study, integrating systematic review with expert and patient perspectives

Abstract

Background: Triage is implemented in healthcare settings to optimise access to appropriate care and manage waiting times.

Objectives: To determine the optimum features of triage systems for patients with musculoskeletal conditions.

Data sources: AMED, BNI, CINAHL, EMBASE, Health Business Elite, HMIC, MEDLINE, Cochrane Library, Web of Science and Google Scholar.

Study selection or eligibility criteria: Studies that included non-musculoskeletal conditions, concerned patients aged <18 years or were set in emergency departments were excluded.

Study appraisal and synthesis methods: Study quality was graded using the Downs and Black quality index. Qualitative methods were used to further inform the findings of the literature review.

Results: Thirty-four studies met the inclusion criteria, with study quality ranging from eight to 24 out of a possible 27. Musculoskeletal triage is conducted via face-to-face consultation, paper referral letter or telephone consultation. Triage performed by physiotherapists, general practitioners, multidisciplinary teams, nurses, occupational therapists and speech therapists has been shown to be effective using a range of outcomes. Qualitative data revealed the value of supportive interdisciplinary teams, and suggested that this support is more important than choice of clinician. Patients trusted, and expressed preferences for, experienced clinicians to perform triage.

Conclusion: Triage can be performed effectively via a number of methods and by a range of clinicians. Satisfaction, cost, diagnostic agreement, appropriateness of referral and waiting list time have been improved though triage. Multidisciplinary support mechanisms are critical elements of successful triage systems. Patients are more concerned with access issues than professional boundaries.

Keywords: Appropriateness; Effectiveness; Length of stay; Referral; Satisfaction; Waiting list.