title: Triage of Rheumatology Referrals Facilitates Wait Time Benchmarks.
abstract: In 2014 the Canadian Rheumatology Association published wait time benchmarks for inflammatory arthritis (IA) and connective tissue disease (CTD) to improve patient outcomes. This study's aim was to determine whether centralized triage and the introduction of quality improvement initiatives would facilitate achievement of wait time benchmarks.
  
  
  
  Referrals from September to November 2012 were retrospectively triaged by an advanced practice physiotherapist (APP) and compared to referrals triaged by an APP from January to March 2014. Each referral was assigned a priority ranking and categorized into one of 2 groups: suspected IA/CTD, or suspected non-IA/CTD. Time to initial consult and time to notification from receipt of referral were assessed.
  
  
  
  A total of 558 (n = 227 and n = 331 from 2012 and 2014, respectively) referrals were evaluated with 35 exclusions. In 2012, there were 96 (42.5%) suspected IA/CTD and 124 (54.9%) suspected non-IA/CTD patients at the time of the initial consult. Mean wait times in 2012 for patients suspected to have IA was 33.8 days, 95% CI 27.8-39.8, compared to 37.3 days, 95% CI 32.9-41.7 in suspected non-IA patients. In 2014, there were 131 patients (43%) with suspected IA based on information in the referral letter. Mean wait times in 2014 for patients suspected to have IA was 15.5 days, 95% CI 13.85-17.15, compared to 52.2 days, 95% CI 46.3-58.1 for suspected non-IA patients. Time to notification of appointment improved from 17 days to 4.37 days.
  
  
  
  Centralized triage of rheumatology referrals and quality improvement initiatives are effective in improving wait times for priority patients as determined by paper referral.
authors: From the Women's College Hospital Rheumatology Department; Department of Physical Therapy, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. chandra.farrer@wchospital.ca.|C. Farrer, BScPT, Clinical Lecturer, Department of Physical Therapy, University of Toronto; L. Abraham, BSc, University of Toronto; D. Jerome, MD, FRCPC, MEd, Assistant Professor, Department of Medicine, University of Toronto, and Division Head of Rheumatology, Women's College Hospital; J. Hochman, MD, FRCPC, MSc, Assistant Professor, Department of Medicine, University of Toronto; N. Gakhal, MD, FRCPC, MSc, Lecturer, Department of Medicine, University of Toronto. chandra.farrer@wchospital.ca.
authors: Chandra
authors: C
authors: Farrer
authors: From the Women's College Hospital Rheumatology Department; Department of Physical Therapy, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|C. Farrer, BScPT, Clinical Lecturer, Department of Physical Therapy, University of Toronto; L. Abraham, BSc, University of Toronto; D. Jerome, MD, FRCPC, MEd, Assistant Professor, Department of Medicine, University of Toronto, and Division Head of Rheumatology, Women's College Hospital; J. Hochman, MD, FRCPC, MSc, Assistant Professor, Department of Medicine, University of Toronto; N. Gakhal, MD, FRCPC, MSc, Lecturer, Department of Medicine, University of Toronto.
authors: Liza
authors: L
authors: Abraham
authors: From the Women's College Hospital Rheumatology Department; Department of Physical Therapy, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|C. Farrer, BScPT, Clinical Lecturer, Department of Physical Therapy, University of Toronto; L. Abraham, BSc, University of Toronto; D. Jerome, MD, FRCPC, MEd, Assistant Professor, Department of Medicine, University of Toronto, and Division Head of Rheumatology, Women's College Hospital; J. Hochman, MD, FRCPC, MSc, Assistant Professor, Department of Medicine, University of Toronto; N. Gakhal, MD, FRCPC, MSc, Lecturer, Department of Medicine, University of Toronto.
authors: Dana
authors: D
authors: Jerome
authors: From the Women's College Hospital Rheumatology Department; Department of Physical Therapy, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|C. Farrer, BScPT, Clinical Lecturer, Department of Physical Therapy, University of Toronto; L. Abraham, BSc, University of Toronto; D. Jerome, MD, FRCPC, MEd, Assistant Professor, Department of Medicine, University of Toronto, and Division Head of Rheumatology, Women's College Hospital; J. Hochman, MD, FRCPC, MSc, Assistant Professor, Department of Medicine, University of Toronto; N. Gakhal, MD, FRCPC, MSc, Lecturer, Department of Medicine, University of Toronto.
authors: Jacqueline
authors: J
authors: Hochman
authors: From the Women's College Hospital Rheumatology Department; Department of Physical Therapy, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|C. Farrer, BScPT, Clinical Lecturer, Department of Physical Therapy, University of Toronto; L. Abraham, BSc, University of Toronto; D. Jerome, MD, FRCPC, MEd, Assistant Professor, Department of Medicine, University of Toronto, and Division Head of Rheumatology, Women's College Hospital; J. Hochman, MD, FRCPC, MSc, Assistant Professor, Department of Medicine, University of Toronto; N. Gakhal, MD, FRCPC, MSc, Lecturer, Department of Medicine, University of Toronto.
authors: Natasha
authors: N
authors: Gakhal
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000628:therapy*; D019985:Benchmarking; D002170:Canada; D003240:Connective Tissue Diseases / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D012017:Referral and Consultation; D012219:Rheumatology; D061665:Time-to-Treatment; D014218:Triage
keywords: ARTHRITIS; QUALITY IMPROVEMENT; RHEUMATOLOGY; TRIAGE