Skip to main content

Advertisement

SpringerLink
Log in

Review of a rheumatology triage system: simple, accurate, and effective

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Rheumatology triage systems exist to expedite care for those with inflammatory arthritis (IA). This study presents the first 22-month experience of a simple and unique Canadian university-based triage system. Triage accuracy is analyzed as is the effect on access to care for patients with IA. The triage rheumatologist screens all incoming referral letters to attempt to identify possible diagnoses and, consequently, assigns urgency of assessment. The wait time for patients with IA after introduction of the triage system was compared to a random sample of IA patients from the year preceding the triage system. All newly referred IA patients who were incorrectly triaged as a non-inflammatory process were identified, with a subsequent chart review examining for features that may have influenced the triage status. Three thousand four hundred seventy-six new referrals were seen, with 344 patients receiving a final diagnosis of IA. The median wait time for all patients was 57.0 days, 37.5 days for IA patients, and 25.0 days for IA patients assigned a soon urgency status. Compared to the preceding year, this latter group with inflammatory arthritis was seen 25.0 days sooner (p < 0.0001). Thirty-one patients with inflammatory arthritis were incorrectly screened as a non-inflammatory process, 10 of whom had features in the referral letter or investigations suggestive of IA. This triage system correctly identifies patients with IA with an accuracy of 91.0 % and effectively reduces their wait time when assigned an appropriate urgency status. Utilization of this triage system may be universally applicable, accurate, and a cost-effective way to optimize rheumatology patients’ access to care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Perruccio AV, Power JD, Badley EM (2006) Revisiting arthritis prevalence projections—it’s more than just the aging of the population. J Rheum 33(9):1856–1862

    PubMed  Google Scholar 

  2. The Arthritis Society. Arthritis Facts and Figures, 2013. Available from: http://www.arthritis.ca/document.doc?id=338. Accessed 21 Jan 2013

  3. Hanly JG (2004) Physician resources and postgraduate training in Canadian academic rheumatology centers: a 5-year prospective study. J Rheum 31(6):1200–1205

    PubMed  Google Scholar 

  4. Dalhousie Department of Medicine. Triage Process and Wait Time Standards For Ambulatory Care, Sept 30, 2012. Available from: http://dom.medicine.dal.ca/waittimes/Rheumatology/currentwaittimes.pdf. Accessed 21 Jan 2013

  5. Kumar K, Daley E, Carruthers DM, Situnayake D, Gordon C, Grindulis K et al (2007) Delay in presentation to primary care physicians is the main reason why patients with rheumatoid arthritis are seen late by rheumatologists. Rheumatology 46(9):1438–1440

    Article  CAS  PubMed  Google Scholar 

  6. Möttönen T, Hannonen P, Korpela M et al (2002) Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum 46(4):894–898

    Article  PubMed  Google Scholar 

  7. Irvine S, Munro R, Porter D (1999) Early referral, diagnosis, and treatment of rheumatoid arthritis: evidence for changing medical practice. Ann Rheum Dis 58(8):510–513

    Article  CAS  PubMed  Google Scholar 

  8. Emery P, Breedveld FC, Dougados M, Kalden JR, Schiff MH, Smolen JS (2002) Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Ann Rheum Dis 61(4):290–297

    Article  CAS  PubMed  Google Scholar 

  9. Jamal S, Alibhai SMH, Badley EM, Bombadier C (2011) Time to treatment for new patients with rheumatoid arthritis in a major Metropolitan City. J Rheum 38(7):1282–1288

    Article  PubMed  Google Scholar 

  10. Tavares R, Pope JE, Tremblay JL, Thorne C, Bykerk VP, Lazovskis J et al (2012) Time to disease-modifying antirheumatic drug treatment in rheumatoid arthritis and its predictors: a national, multicenter, retrospective cohort. J Rheum 39(11):2088–2097

    Article  PubMed  Google Scholar 

  11. Criswell LA, Such CL, Yelin EH (1997) Differences in the use of second-line agents and prednisone for the treatment of rheumatoid arthritis by rheumatologists and non-rheumatologists. J Rheum 24:2283–2290

    CAS  PubMed  Google Scholar 

  12. Cush JJ (2005) Remodeling a rheumatology practice to facilitate early referral. Rheum Dis Clin of N Am 31(4):591–604

    Article  Google Scholar 

  13. Bykerk V, Emery P (2010) Delay in receiving rheumatology care leads to long-term harm. Arthritis Rheum 62(12):3519–3521

    Article  PubMed  Google Scholar 

  14. Zeidler H (2012) The need to better classify and diagnose early and very early rheumatoid arthritis. J Rheum 39(2):212–217

    Article  PubMed  Google Scholar 

  15. van der Linden MPM, le Cessie S, Raza K, van der Woude D, Knevel R, Huizinga TWJ et al (2010) Long-term impact of delay in assessment of patients with early arthritis. Arthritis Rheum 62(12):3537–3546

    Article  PubMed  Google Scholar 

  16. Kiely PDW, Brown AK, Edwards CJ, O’Reilly DT, Ostor AJK, Quinn M et al (2009) Contemporary treatment principles for early rheumatoid arthritis: a consensus statement. Rheumatology 48(7):765–772

    Article  PubMed  Google Scholar 

  17. Newman ED, Harrington TM, Olenginski TP, Perruquet JL, McKinley K (2004) The rheumatologist can see you now?: Successful implementation of an advanced access model in a rheumatology practice. Arthritis Rheum 51(2):253–257

    Article  PubMed  Google Scholar 

  18. Fitzgerald A, de Coster C, McMillan S, Naden R, Armstrong F, Barber A et al (2011) Relative urgency for referral from primary care to rheumatologists: The Priority Referral Score. Arthritis Care Res 63(2):231–9

    Article  Google Scholar 

  19. Hazlewood G, Lupton T, Martin L, Barr S (2010) Methods to improve the triage accuracy of referrals for possible inflammatory polyarthritis [abstract]. J Rheum 37(6):43A

    Google Scholar 

  20. Robinson PC, Taylor WJ (2010) Time to treatment in rheumatoid arthritis. J Clin Rheum 16(6):267–273

    Article  Google Scholar 

  21. Delaurier A, Bernatsky S, Baron M, Légaré J, Feldman DE (2012) Wait times for rheumatology consultation. J Clin Rheum 18(7):341–344

    Article  Google Scholar 

  22. Raza K, Stack R, Kumar K, Filer A, Detert J, Bastian H et al (2011) Delays in assessment of patients with rheumatoid arthritis: variations across Europe. Ann Rheum Dis 70(10):1822–1825

    Article  PubMed  Google Scholar 

  23. Stack RJ, Shaw K, Mallen C, Herron-Marx S, Horne R, Raza K (2012) Delays in help seeking at the onset of the symptoms of rheumatoid arthritis: a systematic synthesis of qualitative literature. Ann Rheum Dis 71(4):493–497

    Article  PubMed  Google Scholar 

Download references

Disclosures

None.

Author information

Authors and Affiliations

  1. Division of Rheumatology, University of Alberta, 562 Heritage Medical Research Centre, University of Alberta, Edmonton, AB, T6G 2S2, Canada

    Thirza Carpenter & Steven J. Katz

Authors
  1. Thirza Carpenter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven J. Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven J. Katz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carpenter, T., Katz, S.J. Review of a rheumatology triage system: simple, accurate, and effective. Clin Rheumatol 33, 247–252 (2014). https://doi.org/10.1007/s10067-013-2413-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-013-2413-1

Keywords

Search

Navigation