title: Musculoskeletal triage: a mixed methods study, integrating systematic review with expert and patient perspectives.
abstract: BACKGROUND
  Triage is implemented in healthcare settings to optimise access to appropriate care and manage waiting times.
  
  
  OBJECTIVE
  To determine the optimum features of triage systems for patients with musculoskeletal conditions.
  
  
  METHODS
  AMED, BNI, CINAHL, EMBASE, Health Business Elite, HMIC, MEDLINE, Cochrane Library, Web of Science and Google Scholar.
  
  
  METHODS
  Studies that included non-musculoskeletal conditions, concerned patients aged <18 years or were set in emergency departments were excluded.
  
  
  METHODS
  Study quality was graded using the Downs and Black quality index. Qualitative methods were used to further inform the findings of the literature review.
  
  
  RESULTS
  Thirty-four studies met the inclusion criteria, with study quality ranging from eight to 24 out of a possible 27. Musculoskeletal triage is conducted via face-to-face consultation, paper referral letter or telephone consultation. Triage performed by physiotherapists, general practitioners, multidisciplinary teams, nurses, occupational therapists and speech therapists has been shown to be effective using a range of outcomes. Qualitative data revealed the value of supportive interdisciplinary teams, and suggested that this support is more important than choice of clinician. Patients trusted, and expressed preferences for, experienced clinicians to perform triage.
  
  
  CONCLUSIONS
  Triage can be performed effectively via a number of methods and by a range of clinicians. Satisfaction, cost, diagnostic agreement, appropriateness of referral and waiting list time have been improved though triage. Multidisciplinary support mechanisms are critical elements of successful triage systems. Patients are more concerned with access issues than professional boundaries.
authors.affiliation: Centre for Sports and Exercise Medicine, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, UK; Clinical Research Centre for Movement Disorders and Gait, Southern Health Centre, Victoria, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Joseph
authors.affiliation: Centre for Sports and Exercise Medicine, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, UK; Physiotherapy Department, Bart's Health NHS trust, London, UK. Electronic address: d.morrissey@qmul.ac.uk.
authors.forename: D
authors.initials: D
authors.lastname: Morrissey
authors.affiliation: Centre for Sports and Exercise Medicine, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Abdur-Rahman
authors.affiliation: Centre for Sports and Exercise Medicine, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Hussenbux
authors.affiliation: Centre for Sports and Exercise Medicine, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, UK; Complete Sports Care, Melbourne, Victoria, Australia; Musculoskeletal Research Centre, La Trobe University, Bundoora, Victoria, Australia; Pure Sports Medicine, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Barton
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult; D019033:Delivery of Health Care, Integrated / Q000379:methods; D005104:Expert Testimony; D033183:Interdisciplinary Communication; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000534:rehabilitation; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities; D011786:Quality Control; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013689:Telephone / Q000706:statistics & numerical data; D014218:Triage / Q000379:methods
keywords: Appropriateness; Effectiveness; Length of stay; Referral; Satisfaction; Waiting list