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. 2018 Jun 1;19(1):181.
doi: 10.1186/s12891-018-2106-7.

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit

Orna Fennelly  1 , Catherine Blake  2 , Oliver FitzGerald  3 , Roisin Breen  4 , Jennifer Ashton  5 , Aisling Brennan  6 , Aoife Caffrey  3   7 , François Desmeules  8 , Caitriona Cunningham  2
Affiliations

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit

Orna Fennelly et al. BMC Musculoskelet Disord. .

Abstract

Background: Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services.

Method: Throughout 2014, APPs (n = 22) entered clinical data on a national database. Analysis of these data using descriptive statistics determined patient wait times, Consultant Doctor involvement in clinical decisions, and patient clinical outcomes. Chi square tests were used to compare patient clinical outcomes across orthopaedic and rheumatology clinics. A pilot study at one site identified re-referral rates to orthopaedic/rheumatology services of patients managed by the APPs.

Results: In one year, 13,981 new patients accessed specialist orthopaedic and rheumatology consultations via the APP. Median wait time for an appointment was 5.6 months. Patients most commonly presented with knee (23%), lower back (22%) and shoulder (15%) disorders. APPs made autonomous clinical decisions regarding patient management at 77% of appointments, and managed patient care pathways without onward referral to Consultant Doctors in more than 80% of cases. Other onward clinical pathways recommended by APPs were: physiotherapy referrals (42%); clinical investigations (29%); injections administered (4%); and surgical listing (2%). Of those managed by the APP, the pilot study identified that only 6.5% of patients were re-referred within one year.

Conclusion: This national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment. Therefore, patients gained earlier access to orthopaedic and rheumatology consultations in secondary care, with most patients conservatively managed.

Keywords: Advanced practice; Healthcare service research; Orthopaedics; Physiotherapy; Rheumatology; Triage.

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Conflict of interest statement

Authors’ information

OFe is a PhD researcher and physiotherapist who has not worked in the advanced practice physiotherapist role. JA, AB and AC work in the advanced practice physiotherapist roles. OFi is a Consultant Rheumatologist who works alongside advanced practice physiotherapists and formerly Clinical Lead of the National Clinical Programme for Rheumatology. RB was a physiotherapy manager and formerly the Programme Manager for the National Clinical Programme for Rheumatology. CC and CB are physiotherapists and lecturers at UCD. FD is a physiotherapist and lecturer at the University of Montreal.

Ethics approval and consent to participate

Full ethical approval was received from University College Dublin’s Human Research Ethics Committee (ref. LS-16-04-Fennelly-C), with permission from the National Clinical Programmes, and the Ethics and Medical Research Committee at St. Vincent’s University Hospital (SVUH), Dublin. Participant consent was not necessary as this study involved the use of an anonymised database which is not considered ‘personal data’ according to the Data Protection Act 1988.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Body regions of the MSK disorders of new patients presenting to the orthopaedic and rheumatology APP services (n = 13,367)
See this image and copyright information in PMC

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