LAY SUMMARY
In Canada, patients can wait over a year to be seen by an orthopedic surgeon. To reduce wait times, physiotherapists have been employed in some practice areas to triage patients prior to being seen by an orthopedic surgeon. This study looked at different forms of triage by using physiotherapists to screen electronic medical records (EMR) to determine if patients needed orthopedic intervention or conservative management. To guide the physiotherapists, a screening tool was created. The study compared the recommendations of the physiotherapists with those of an orthopedic surgeon. The results showed that, most of the time, physiotherapists using the screening tool successfully identified whether a patient needed to see an orthopedic surgeon or could be treated with physiotherapy. This type of screening process may decrease wait times to see an orthopedic surgeon and improve access to physiotherapy or other treatments.
Introduction: In Canada, wait times for orthopedic surgery represent a significant delay in care for patients with musculoskeletal disorders. To improve access, new models of care involving physiotherapists to either diagnose, triage, and/or conservatively manage patients with musculoskeletal disorders are being implemented. The purpose of this study was to assess the effectiveness of physiotherapy-led screening of electronic medical records (EMR) using a locally developed screening tool to identify whether patients required orthopedic intervention or conservative management. Methods: The EMRs of 41 patients, referred to orthopedic surgery for any musculoskeletal disorder in an outpatient orthopedic clinic within a military primary health care centre in Halifax, Canada, were independently screened by two randomly assigned physiotherapists. The corresponding patients were subsequently seen by one orthopedic surgeon. The physiotherapists screened the EMRs using a screening tool and provided triage recommendations (orthopedic intervention, physiotherapy, physiatry, diagnostic investigations, or other intervention). Percentage of agreement and Fleiss’ kappa were calculated to assess inter-rater agreement, and validity was determined by cross-tabulation. Results: The percentage of agreement for triage recommendations among physiotherapists was 78% and inter-rater agreement was moderate (κ = 0.617; 95% CI, 0.365–0.868, p < 0.001). Excluding recommendations for diagnostic investigations increased the percentage of agreement to 93.9% and resulted in a strong level of inter-rater agreement (κ = 0.878; 95% CI, 0.537–1.219). The screening tool was determined to have 64.0% sensitivity, 87.5% specificity, a positive predictive value of 88.9%, and a negative predictive value of 63.2%. Discussion: EMR screening may have a role in identifying patients that require orthopedic intervention; however, more research is needed.