Rationing of hip and knee referrals in the public hospital: the true unmet need.
OBJECTIVE
The aim of this paper is to outline the development of a triage system for elective hip and knee referrals to the Orthopaedic Department of the Canterbury District Health Board (CDHB), and to determine the unmet need within this population for accessing first specialist assessment (FSA).


METHODS
Between 1 August 2015 and 31 March 2016 data was collected from all elective hip and knee referrals that underwent triage for a FSA. The number of outpatient appointments available according to the government four-month waiting time is set by the CDHB. Patients were triaged by two consultant surgeons on the basis of their referral letter and radiological imaging into one of five categories: accepted for FSA, insufficient information, no capacity, low priority or direct entry to waiting list (if already seen by a specialist). Those not accepted for an FSA were returned to general practitioner (GP) care.


RESULTS
During the study period there were 1,733 referrals (838 hip related referrals and 895 knee related referrals) to the orthopaedic department with a request for FSA. All patients had failed conservative management. Of these referrals 43% of hip and 54% of knee related referrals could not be offered an FSA and were returned, following triage, to general practitioner care unseen. Only 8% and 9% respectively were declined for insufficient information in the referral letter or lack of need.


CONCLUSIONS
This study details the implementation of a triage system for elective hip and knee referrals to the CDHB and with accurate data we have been able to determine the large number of patients unable to access a specialist opinion. These patients represent the unmet need within our community and highlights the degree of rationing taking place within the public hospital.
Orthopaedic Trainee, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch.
Tom
T
Inglis
Orthopaedic Surgeon, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch.
Paul
P
Armour
Orthopaedic Surgeon, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch.
Grahame
G
Inglis
Professor of Orthopaedics, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch.
Gary
G
Hooper
D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D017558:Elective Surgical Procedures; D058005:General Practitioners; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006779:Hospitals, Public; D006801:Humans; D009520:New Zealand; D000072161:Orthopedic Surgeons; D015207:Osteoarthritis, Hip / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000601:surgery*; D018579:Patient Selection; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014218:Triage / Q000379:methods*; D014850:Waiting Lists