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Orthopaedic triage: cost effectiveness, diagnostic/surgical and management rates

Damon Burn (Walsall Healthcare NHS Trust, Walsall, UK)
Elaine Beeson (Walsall Healthcare NHS Trust, Walsall, UK)

Clinical Governance: An International Journal

ISSN: 1477-7274

Article publication date: 1 April 2014



The purpose of this paper is to investigate cost effectiveness, diagnostic rates, surgical percentage and appropriateness for orthopaedic referrals and number of patients able to be seen in orthopaedic triage from GP orthopaedic referrals.


The study involved triaging paper referrals for orthopaedic outpatients to an interface service, orthotics or continue normal route. Data were collected on outcome of the interface appointment and outcomes for those patients referred to orthopaedics from the appointment.


The study demonstrated a 27.3 per cent cost saving from the normal orthopaedic route with 86.1 per cent of patients able to be managed by an extended scope physiotherapist (ESP) without requiring orthopaedic assessment. Appropriateness of onward orthopaedic referrals was 80.5 per cent with surgery conversion rate of 75 per cent.


Although triage and ESP positions have been studied before, this is the first known study to look at cost effectiveness across the patient pathway despite this being a large reason for the creation of these positions. Further larger studies are required to build upon this base in terms of demonstrating the cost effectiveness of the value of these positions.



Burn, D. and Beeson, E. (2014), "Orthopaedic triage: cost effectiveness, diagnostic/surgical and management rates", Clinical Governance: An International Journal, Vol. 19 No. 2, pp. 126-136.



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