title: Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care.
abstract: OBJECTIVE
  To investigate the impact, quality and acceptability of a musculoskeletal screening clinic provided by physiotherapists for patients referred to the outpatient orthopaedic department at a major metropolitan hospital.
  
  
  METHODS
  Prospective observational trial undertaken between 29 November 2005 and 6 June 2006 at the Northern Hospital (a tertiary teaching hospital in outer Melbourne) of 52 patients with non-urgent musculoskeletal conditions who were assessed by one of two physiotherapists with postgraduate qualifications and subsequently by an orthopaedic surgeon.
  
  
  METHODS
  Proportion of new patients referred who could have been managed without needing to see a surgeon; level of agreement between physiotherapists and orthopaedic surgeon on diagnoses and management decisions; and levels of satisfaction of patients, referring general practitioners and the orthopaedic surgeon with the physiotherapist-led screening initiative.
  
  
  RESULTS
  45 of 52 selected patients (31 women and 21 men; mean age, 53.3 years) attended their appointment with the physiotherapist; of these, 38 also attended a later appointment with the orthopaedic surgeon. Seven of the 38 patients were listed for surgery, and seven others needed management by the surgeon (injection for three, imaging for four). Almost two-thirds (63%) were appropriate for non-surgical management. The physiotherapists identified the same patient management plans as the surgeon for 74% of the group. Patients and doctors reported high levels of satisfaction with the physiotherapist-led service.
  
  
  CONCLUSIONS
  Nearly two-thirds of patients with non-urgent musculoskeletal conditions referred by their GPs to one public outpatient orthopaedic department did not need to see a surgeon at the time of referral, and were appropriately assessed and managed by experienced, qualified physiotherapists.
authors.affiliation: Northern Hospital, Melbourne, Victoria, Australia. L.Oldmeadow@alfred.org.au
authors.forename: Leonie B
authors.initials: LB
authors.lastname: Oldmeadow
authors.forename: Harvinda S
authors.initials: HS
authors.lastname: Bedi
authors.forename: Hugh T
authors.initials: HT
authors.lastname: Burch
authors.forename: Jenni S
authors.initials: JS
authors.lastname: Smith
authors.forename: Edmund S
authors.initials: ES
authors.lastname: Leahy
authors.forename: Miron
authors.initials: M
authors.lastname: Goldwasser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D005260:Female; D020793:Gatekeeping; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000628:therapy; D009985:Orthopedics; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D026761:Physical Therapy Specialty; D011446:Prospective Studies; D014739:Victoria