title: What is orthopaedic triage? A systematic review.
abstract: OBJECTIVE
  Complex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often described as 'triage' services. This paper reviews the literature pertaining to definitions and descriptions of orthopaedic/musculoskeletal triage processes, in order to provide information on 'best practice' to assist health care facilities.
  
  
  METHODS
  A comprehensive open-ended search was conducted using electronic databases to identify studies describing models of triage clinics for patients with a musculoskeletal/orthopaedic complaint, who have been referred to hospital outpatient clinics for a surgical consultation. Studies were critically appraised using the McMaster quality appraisal tool and ranked using the National Health and Medical Research Council hierarchy of evidence. A thematic analysis of the definitions, processes and procedures of triage described within the literature was undertaken.
  
  
  RESULTS
  1930 studies were identified and 45 were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from I to IV; however, the majority were at low levels of evidence and scored poorly on the critical appraisal tool. Three broad themes of triage were identified: presence of a referral, configuration of the triage (who, how and where) and the aim of triage. However, there were significant inconsistencies across these themes.
  
  
  CONCLUSIONS
  This systematic review highlighted the need for standardization of the definition of triage, the procedures of assessment and management and measures of outcome used in orthopaedic/musculoskeletal triage to ensure best-practice processes, procedures and outcomes for triage clinics.
authors.affiliation: Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.
authors.forename: Joanne H
authors.initials: JH
authors.lastname: Morris
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: James
authors.forename: Rachel
authors.initials: R
authors.lastname: Davey
authors.forename: Gordon
authors.initials: G
authors.lastname: Waddington
mesh_terms: D006282:Health Personnel / Q000458:organization & administration; D006801:Humans; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000628:therapy*; D009985:Orthopedics; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration* / Q000592:standards; D012017:Referral and Consultation / Q000458:organization & administration; D014218:Triage / Q000458:organization & administration* / Q000592:standards
keywords: orthopaedic/musculoskeletal triage; role substitution; systematic review; triage clinics; workforce redesign