Background/Purpose:

We are piloting a children and young people (CYP) community-based triage (called Rightpath) based on a validated adult MSK triage model developed by Pennine MSK Partnership Ltd (PMSKP), Greater Manchester. Rightpath aims to promptly identify CYP with MSK pathology and triage them to the appropriate service (rheumatology, orthopaedics, neurodisability or urgent care), and to manage those who do not need specialist referral appropriately within the community. Triage and referral guidance has been developed in partnership with MSK specialists and this study aims to test its safety, feasibility and acceptability in the community, and through application across two geographical areas in the UK to assess transferability.

Methods:

Piloted first at PMSKP, with iteration of the triage guidance and process followed by roll out at a second site (South Tyneside NHS Trust). Using mixed methods, evaluation focused on key areas:

Implementation – workshops with service providers (triagers and clinicians) held at two time points to refine triage guidance and process.

Training – for triagers based on their weekly log of triage experiences and regular case based discussions and feedback.

Evaluation – (i) Parent/ patient questionnaire, incorporating the ‘Friends and Family’ test and ‘Collaborate’ (a patient reported measure of shared decision-making), completed immediately after consultation to explore expectations and satisfaction; (ii) Service providers weekly log documenting experiences and training needs; (iii) Routine patient data including demographic details, referral information, triage outcome, ultimate diagnosis/outcome and communication between triage teams and health care providers; (iv) Service providers signposted to key areas for self-directed learning (paediatric musculoskeletal matters [PMM] – www.pmmonline.org) and usage monitored.

This study had ethical approval.

Results:

Total triaged 05/09/16 – 30/04/17 (101 to Rightpath, 264 to specialist paediatric services). The most common CYP MSK referrals from the community were knee pain, foot pain, flat feet and back pain; the most common conditions triaged to Rightpath were foot pain, knee pain, flat feet, and in-toeing. No significant pathology has been triaged inappropriately so far to Rightpath. Feedback from 66 Rightpath family participants was positive (no complaints or requests for onward specialist referral); 100% would recommend the service, with satisfaction (1-10) scores about community providers being high (1=’no’ and 9=’every’ effort made); ‘helped understand your/your child’s health issues’ (8.9), ‘listened to things that matter most to you about your/your child’s health’ (8.9), ‘included what matters most to you in choosing what to do next’ (8.9). Community therapists and podiatry described the clinical workload to be appropriate for their existing skills. Triage staff deemed the triage process manageable (57% of decisions ‘easy/very easy’) and triage guidance to be useful commenting that paediatric experience was important to support decision-making.

Conclusion:

Initial data shows Rightpath to be feasible, safe and acceptable. Phase 2 of the pilot is in progress at the second site.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/paediatric-musculoskeletal-msk-triage-in-the-community-rightpath-a-pilot-study/