Prioritizing patients for Community Rehabilitation Services: do clinicians agree on triage decisions?
OBJECTIVE
To evaluate agreement between independent clinician raters using a triage protocol to prioritize referrals for occupational therapy and physiotherapy within a community rehabilitation program.


METHODS
The priority category allocated to consecutive referrals by one of six clinicians in the referral office was compared with a second rating made by an independent occupational therapist, blinded to the initial priority rating.


METHODS
A centralized referral office staffed by allied health and nursing professionals designed as a single point of access for sub acute and ambulatory services within a large metropolitan health network.


METHODS
214 referrals for adults requiring community based occupational therapy or physiotherapy rehabilitation for orthopaedic, neurological or other conditions (such as falls or cardio-respiratory conditions).


METHODS
Agreement (weighted kappa = κ(w)) between the two ratings.


RESULTS
Overall agreement was moderate (κ(w) = 0.60), but disagreement occurred in 30% of cases. Professional discipline of the raters did not affect agreement. Agreement varied between diagnostic subgroups, with significantly lower agreement for referrals for rehabilitation following elective orthopaedic surgery (κ(w) = 0.25) than the other categories combined. Differences in agreement were observed between the four triage categories, with the lowest observed agreement in the most urgent category.


CONCLUSIONS
Clinicians in a centralized model of triage showed only moderate agreement when making decisions about client priority for community rehabilitation for occupational therapy and physiotherapy.
Harding
Katherine E
KE
La Trobe University, Faculty of Health Sciences and Eastern Health, Australia. katherine.harding@easternhealth.org.au
Taylor
Nicholas F
NF
Leggat
Sandra G
SG
Wise
Vicki L
VL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000592:standards; D005260:Female; D006292:Health Priorities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009788:Occupational Therapy / Q000592:standards* / Q000706:statistics & numerical data; D018579:Patient Selection; D026741:Physical Therapy Modalities / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D014218:Triage / Q000592:standards* / Q000706:statistics & numerical data; D014850:Waiting Lists; D055815:Young Adult