A Shoulder/Elbow Triage and Assessment model of care reduced a public orthopaedic shoulder/elbow clinic waitlist with high patient satisfaction

• Published in: ANZ journal of surgery Vol. 93; no. 3; pp. 643 - 648
• Main Authors: Avdalis, Christos, Taylor, Deborah, Cass, Benjamin, Lambert, Tara E., Langron, Genevieve, Mittal, Rajat, Spasojevic, Miloš, Moopanar, Terence R.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.03.2023; Blackwell Publishing Ltd
• Subjects: Adverse events; Clinical outcomes; Elbow; Elbow (anatomy); Humans; orthopaedics; Orthopedics; Pain; Patient Satisfaction; Patients; physiotherapy; Shoulder; Surgeons; Triage; Waiting Lists; elbow; orthopaedics; shoulder; triage; physiotherapy
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.18282

Background Patients referred to public orthopaedic clinics can experience long waiting times before assessment. This study aims to evaluate the effectiveness of a collaborative Shoulder/Elbow Triage and Assessment (SHELTA) model of care involving orthopaedic surgeons and physiotherapists to reduce the waitlist and improve service and clinical outcomes for patients on an orthopaedic shoulder/elbow clinic waitlist. Methods Patients on the waitlist were triaged by surgeons and physiotherapists and invited to an assessment by experienced physiotherapists. Patients were treated nonoperatively or transferred to orthopaedic management based on clinical discussion. The primary outcome was the number of patients on the waitlist. Secondary outcomes included adverse events, patient satisfaction, re‐referral and conversion to surgery rates. Pain, function and patient global impression of change were recorded for participants managed nonoperatively. Results From July 2019 to December 2019, the waitlist reduced from 451 to 298 patients with no adverse events. Seventy‐nine patients could not be contacted and 25 no longer required assessment, and were removed from the waitlist. Nonoperatively managed participants reported satisfaction with the service, a median score of 6 on a 7‐point Patient Global Impression of Change scale, change in pain of −2.5/10 (95% CI −3.3, −1.7; P < 0.001) on a numerical pain rating scale, and change in function of −17.4/100 (95% CI: −24.1, −10.8; P < 0.001) on the QuickDASH, indicating improvement. Conclusions The SHELTA model of care effectively reduced the number of patients on an orthopaedic shoulder/elbow clinic waitlist with good service and clinical outcomes. The implementation of a model of care involving physiotherapists and orthopaedic surgeons to triage, assess and treat patients with shoulder and elbow conditions effectively reduced the number of patients on an orthopaedic shoulder/elbow clinic waitlist. Patients reported high levels of satisfaction with the care received and those who underwent nonoperative treatment had improvements in pain and function. The service performed well, with no adverse events, low re‐referral rates at one year, and increased the conversion to surgery rate for patients seen by orthopaedic surgeons.