The study was undertaken to determine if digital tools could substitute for clinician led triage and ultimately reduce the burden of triage, release clinical capacity, and improve consistency.
A level of agreement study was undertaken comparing the triage decisions made by the digital App and the triage decisions made by the therapist responsible for clinical triage. 115 patients were reviewed by the App and by 12 different MSK Advance Practitioners (AP) over a two week period.
On analysis of the data, there was disagreement between the digital App and the therapist in 16/115 patient records (14%). In all 16 cases, patients were allocated to the urgent MSK specialist pathway by the Digital App which the MSK AP considered to be routine care. In these 16 patients, MSK APs felt that the App was overcautious. When extrapolating this to the volume of urgent referrals seen in the service, a 14% increase in urgent patients would equate to an extra 63 patients per month, which is the equivalent of the workload for 1.0 whole time equivalent (WTE) MSK AP. Although the App would save triage time, the time taken to undertake the triage for 115 patients would be approximately 0.25WTE.
Although the App was able to triage patients safely, the allocation of more patients to ‘urgent care’ rather than ‘routine care’, can lead to a significant service inefficiencies and higher costs. Increased numbers of high priority referrals can increase the waiting times for routine patients particularly where there are already demand and capacity constraints such as in the UK health economy. In such health economies even small increases in urgent referrals can have fairly severe consequences for waiting list management.
Although digital technology has the possibility to transform services, new digital care pathways should be piloted and rigorously scrutinised to ensure they are making a positive impact to efficiency and the quality of patient care.
Triage
MSK
