Effectiveness of a physiotherapy-initiated telephone triage of orthopedic waitlist patients

Joanne Morris¹, Karen Grimmer-Somers², Saravana Kumar², Karen Murphy³, Lisa Gilmore¹, Bryan Ashman¹, Chandima Perera¹, Kathryn Vine¹, Corinne Coulter^1
1The Canberra Hospital, ACT Government Health Directorate, Canberra, ACT, Australia; ²International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia; ³ACT Government Health Directorate, Canberra, ACT, Australia

Background: There is generally a lengthy wait on outpatient orthopedic waiting lists in Australian public hospitals to consult a specialist. Patients then wait again for surgery, if required. Patients with higher need are rarely prioritized, and there is the potential for increased morbidity for those who wait. There is generally no option of alternative care whilst waiting. This paper compares historical orthopedic outpatient clinic data with the outcomes of a physiotherapy-led initiative in one large Australian tertiary hospital.
Methods: Two physiotherapists working within-scope conducted a telephone triage (October to December 2010) using a standard instrument for all new patients on the orthopedic waiting list. They were offered primary treatment options of retaining their appointment, being discharged, referral to a new model of assessment (multidisciplinary specialist clinic), or referral to physiotherapy. The outcomes were costs of the service, waiting time, and percentage of patients taking up management options. This was compared with a historical sample of new patients on the orthopedic waiting list (January to March 2009), whose treatment consumption was tracked longitudinally.
Results: The telephone triage resulted in 16.4% patients being discharged directly (compared with 0.1% comparison sample). For approximately AU$17.00 per patient, the telephone triage process released 21 booked appointments on the outpatient clinic waiting list. Moreover, approximately 26% patients were referred directly to physiotherapy, which was not a primary management option in the comparison sample. The waiting time for an appointment, for those patients who remained on the waiting list, was significantly shorter for the telephone triage sample than the comparison sample. There were significantly higher rates of failure to attend appointments, and significantly lower rates of discharge, in the comparison sample, than the telephone triage sample.
Conclusion: A physiotherapist-led intervention offering alternative management options whilst patients waited for an orthopedic outpatient clinic consultation appears to be cost-effective, and patient-centered.

Keywords: extended scope practice, orthopedics, evaluation