Efficacy of musculoskeletal assessment services

Abstract

It is important that the clinical effectiveness of referral pathways brought in to streamline patient care are critically evaluated. One such pathway for orthopaedic patients is a musculoskeletal community assessment triage service (MCATS). This study examines the service for patients with hip or knee complaints in comparison with referral directly to secondary care. A single general practice referred 432 patients with hip or knee complaints over a 5-year period: 226 through MCATS and 206 directly to secondary care. Time to initial consultation was 4 days longer, on average, in secondary care (p=0.05), but time from referral to achieving a working diagnosis was 11 days longer for MCATS patients (p<0.001), with more consultations required (p<0.001). Overall, the use of cross-sectional imaging was greater at MCATS than in secondary care (p=0.04). Patients referred directly to secondary care required surgical management more frequently (36% vs 16%; p<0.001). GPs can triage patients effectively who are likely to require surgery when referring to hip and knee services. Patients referred to MCATS require more consultations, undergo more cross-sectional imaging and wait longer before a working diagnosis is established, when compared with direct referral to secondary care.