Abstract

SummaryWe introduced an electronic triage system into our osteoporosis service to actively manage referral demand in a busy outpatient service. Our study demonstrated the effectiveness of e-triage in supporting alternative management pathways, through use of virtual advice and direct to investigation services, to improve patient access.PurposeOsteoporosis referrals are increasing with awareness of the potential for prevention of fragility fracture and with complex decision making around management with long-term bisphosphonate therapy. We examined whether active triage of referrals might improve referral management processes and patient access to osteoporosis services.MethodsWe implemented electronic triage (e-triage) of referrals to our osteoporosis service using the Northern Ireland electronic health care record. This included the option of ‘advice only’, direct to investigation with DXA or face-to-face appointments at the consultant-led complex osteoporosis service. We anticipated that there was scope to manage patient flow direct to investigation, or to provide referring clinicians with clinical advice without the need for a face-to-face assessment, at the consultant-led specialist service.ResultsWe reviewed e-triage outcomes of 809 referrals (692 F; 117 M) to osteoporosis specialist services (mean age 65 ± 16.5 years) over a 12-month period. There was a high degree of agreement for the triage category between the referring clinician and specialist services (741/809). 73.3% attended a face-to-face appointment at the consultant-led clinic, while active triage enabled direct to investigation (18.4%) or discharge (8.3%) in the remainder. The mean time between receipt of an electronic referral and e-triage was 3 days over the 12-month period as compared with 2.1 days (median 1.1 days) when annual leave periods were excluded.ConclusionE-triage supports effective referral management in a busy osteoporosis service. Efficiency is limited by reliance on a sole clinician and 5 day working at present. There is scope to further improve systems access through multidisciplinary team working, virtual clinics and future information technology developments.

Highlights

  • Post-menopausal osteoporosis is common and is associated with an increased risk of fracture [1]

  • Fragility fractures arising from osteoporosis affect one in two women and one in five men over the age of 50 years [2]

  • We hypothesised that active e-triage in the osteoporosis service, using the Northern Ireland Electronic Record, would support effective management of patient flow to appropriate specialist osteoporosis services

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Summary

Introduction

Post-menopausal osteoporosis is common and is associated with an increased risk of fracture [1]. Fragility fractures arising from osteoporosis affect one in two women and one in five men over the age of 50 years [2]. Fragility fractures are costly and in the UK National Health Service the hospital costs of hip fractures alone are estimated at £1.1 billion [3]. In some areas within our region, demand for osteoporosis services exceeds the supply, resulting in limited access. With initiatives to support review of long-term bisphosphonate prescriptions, we have observed increasing referral demand to the specialist service from primary care

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