Background/Purpose: Rheumatic and musculoskeletal diseases (RMDs) are the leading contributor of disability worldwide (de Thurah et al 2022). The National Musculoskeletal (MSK) Triage Initiative, ensures patients on Rheumatology and Orthopaedic waiting lists, who are unlikely to require specialist consultant care, are triaged by Clinical Specialist Physiotherapists.

The Wold Health Organisation (WHO) advises the development and implementation of eHealth solutions to optimise patient access (2017). Virtual consultations (VC) were used extensively during COVID-19, but have since reverted to traditional face to face (F2F) or Hybrid (VC +/- F2F) models, with limited evaluation of these to date. Hence the aim of this study was to review the impact of a Hybrid Model (VC +/- F2F) for MSK Triage. 

Methods: Observational retrospective study of MSK Triage data over a 12 month period, using descriptive statistics to summarise and present findings. Ethical approval was received.

Results: A total of 2,373 New Patient (NP) consultations were managed by the MSK team, with almost two-thirds (63.59%, n=1509) screened and scheduled for virtual clinic (VC). Remaining patients (36.41%, n=864) were scheduled for F2F clinics, due to referral information (e.g. motor or sensory loss, language barriers, or lack of contact details to enable VC).   

Of those scheduled for VC, 47.05% (n=710), including patients who did not attend (DNA, n=199), were discharged after initial VC appointment. Almost half (49.23%, n=743) were listed for F2F Review (RV), 2.45% (n=37) were listed for Virtual RV, and 1.35% were referred for Consultant RV (n=19). New patient DNA rates were lower for VC (13.18%, n=199) than F2F clinics (17.93%, n=155).

Outcomes for patients who received their F2F RV appointment (n=468) show that 56.19% (n=263) were subsequently discharged following that appointment. This includes patients who DNA (n=75). Combining this with discharges from VC NP, a discharge rate of (46.32%, n=699) was captured for the Hybrid Model, which is marginally higher than the discharge rate of 44.79% for the traditional F2F model.

Furthermore, the adoption of Hybrid MSK Triage clinics allowed for an increase in NP appointment capacity, facilitating maximum utilisation of clinical resources, and overcoming potential limitations posed by lack of physical clinical space. This has facilitated a reduction in waiting times for MSK triage from 188 weeks to 32 weeks over the one year period. This has also optimised the use of MSK Clinic space at Consultant clinics for more complex patients who may require consultant RV or discussion on the same day.

Conclusion: This study demonstrates merit in using a Hybrid model for MSK Triage, with associated reduction in patient waiting times from more than 3 years to 32 weeks over the one year period, with reduced DNA rates, and no negative impact on patient discharge rates.

Separate studies to explore patient and clinician feedback have been presented elsewhere and reported positive findings (e.g. patients citing benefit in reduced unnecessary hospital journeys of up to 250km).

Further investigation is planned to explore which MSK conditions and other patient parameters may impact the efficiency of Hybrid models for the delivery of MSK Services.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/shaping-the-future-of-the-national-musculoskeletal-msk-triage-initiative-exploring-the-impact-of-a-hybrid-model-virtual-and-face-to-face-of-msk-triage/