title: Review of a rheumatology triage system: simple, accurate, and effective.
abstract: Rheumatology triage systems exist to expedite care for those with inflammatory arthritis (IA). This study presents the first 22-month experience of a simple and unique Canadian university-based triage system. Triage accuracy is analyzed as is the effect on access to care for patients with IA. The triage rheumatologist screens all incoming referral letters to attempt to identify possible diagnoses and, consequently, assigns urgency of assessment. The wait time for patients with IA after introduction of the triage system was compared to a random sample of IA patients from the year preceding the triage system. All newly referred IA patients who were incorrectly triaged as a non-inflammatory process were identified, with a subsequent chart review examining for features that may have influenced the triage status. Three thousand four hundred seventy-six new referrals were seen, with 344 patients receiving a final diagnosis of IA. The median wait time for all patients was 57.0 days, 37.5 days for IA patients, and 25.0 days for IA patients assigned a soon urgency status. Compared to the preceding year, this latter group with inflammatory arthritis was seen 25.0 days sooner (p < 0.0001). Thirty-one patients with inflammatory arthritis were incorrectly screened as a non-inflammatory process, 10 of whom had features in the referral letter or investigations suggestive of IA. This triage system correctly identifies patients with IA with an accuracy of 91.0 % and effectively reduces their wait time when assigned an appropriate urgency status. Utilization of this triage system may be universally applicable, accurate, and a cost-effective way to optimize rheumatology patients' access to care.
authors.affiliation: Division of Rheumatology, University of Alberta, 562 Heritage Medical Research Centre, University of Alberta, Edmonton, AB, T6G 2S2, Canada.
authors.forename: Thirza
authors.initials: T
authors.lastname: Carpenter
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
mesh_terms: D000416:Alberta; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D020399:Practice Management; D016730:Program Development; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012219:Rheumatology / Q000458:organization & administration; D013997:Time Factors; D014218:Triage / Q000379:methods*; D014495:Universities