title: A physiotherapy triage service for orthopaedic surgery: an effective strategy for reducing wait times.
abstract: OBJECTIVE
  To investigate the effectiveness of a physiotherapy triage service for orthopaedic surgery referrals from primary-care physicians.
  
  
  METHODS
  A prospective, observational design was used with patients referred to an orthopaedic surgeon based out of two small urban centres in British Columbia. The level of agreement between the physiotherapist and surgeon was determined using a weighted kappa statistic (κw) with 95% CI. A patient satisfaction questionnaire was administered, and the surgical conversion rate (SCR) was calculated to assess the level of appropriate referrals.
  
  
  RESULTS
  The analysis found substantial agreement (κw=0.77; 95% CI, 0.60-0.94) between surgeon and physiotherapist for surgical management decisions. All patients reported being "satisfied" or "very satisfied" with the overall care they received from the physiotherapist. The SCR of patients referred by the physiotherapist to the surgeon was 91%, versus 22% among patients referred by a general practitioner or emergency physician.
  
  
  CONCLUSIONS
  More than three-fourths of patients referred by primary-care physicians did not need to see a surgeon and were able to be managed by an experienced orthopaedic physiotherapist. This triage model could have considerable impact on orthopaedic wait times in Canada by minimizing unnecessary referrals; the model could also promote timely and conservative management of non-surgical conditions by physiotherapists.
authors.affiliation: Department of Physical Therapy.
authors.forename: Christopher
authors.initials: C
authors.lastname: Napier
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of British Columbia, Vancouver.
authors.forename: Robert G
authors.initials: RG
authors.lastname: McCormack
authors.affiliation: Department of Physical Therapy.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hunt
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of British Columbia, Vancouver.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Brooks-Hill
keywords: gatekeeping; orthopaedics; practice guidelines as topic; waiting lists