title: Deferred care for adults with musculoskeletal complaints.
abstract: BACKGROUND
  Many ambulatory care facilities do not have resources to provide same-day care for all walk-in patients. Yet, there are few guidelines that identify patients for whom care can be safely deferred.
  
  
  OBJECTIVE
  To describe the development and implementation of deferred-care guidelines for adults with musculoskeletal complaints.
  
  
  METHODS
  Consensus process and field test. GUIDELINE DEVELOPMENT: After an eight-member multidisciplinary physician panel identified critical factors that necessitate same-day care, we created 34 clinical scenarios to consider for deferred care. In 22 scenarios, the panel members agreed that deferred care was safe. These were formatted into screening guidelines for back, neck, isolated extremity, and generalized muscle pain.
  
  
  METHODS
  In reliability testing between two nurses reading 40 patient scenarios, interrater agreement for deferred care was nearly perfect (kappa = 0.95). The guidelines were then applied to 448 patients presenting with musculoskeletal complaints to a Veterans Administration ambulatory care triage station. One hundred seven (24%) patients met guidelines for deferred care. Seventy-six patients agreed to have their care deferred, of which 66 kept their return appointment.
  
  
  CONCLUSIONS
  Our guidelines suggest that a substantial proportion of patients with musculoskeletal complaints can have their care deferred. Most patients were willing to do so and kept their follow-up appointment. Use of these guidelines could help decompress ambulatory settings with limited resources to provide nonemergency same-day care.
authors.affiliation: University of California, Los Angeles, Medical School, Los Angeles, Calif., USA. dwashing@ucla.edu
authors.forename: D L
authors.initials: DL
authors.lastname: Washington
authors.forename: P G
authors.initials: PG
authors.lastname: Shekelle
authors.forename: C D
authors.initials: CD
authors.lastname: Stevens
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000628:therapy*; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D018570:Risk Assessment; D014218:Triage