Osteoporosis Service, Musgrave Park Hospital, Belfast Health & Social Care Trust, Stockmans Lane, Belfast, BT9 7JB, UK.
Arch Osteoporos. 2020 Mar 21;15(1):53. doi: 10.1007/s11657-020-0703-1.
We 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.
Osteoporosis 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.
We 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.
We 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.
E-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.
我们在骨质疏松症服务中引入了电子分诊系统，以积极管理繁忙门诊服务中的转介需求。我们的研究表明，电子分诊通过使用虚拟咨询和直接调查服务来支持替代管理途径，从而有效改善了患者的就诊机会。
随着对预防脆性骨折的认识不断提高，以及在长期双磷酸盐治疗管理方面需要进行复杂决策，骨质疏松症的转介数量不断增加。我们研究了积极的分诊是否可以改善转介管理流程和患者获得骨质疏松症服务的机会。
我们在北爱尔兰电子医疗记录中对骨质疏松症服务的转介进行了电子分诊（e-triage）。这包括仅提供咨询、直接进行 DXA 检查或在顾问主导的复杂骨质疏松症服务中进行面对面预约的选项。我们预计，在顾问主导的专科服务中，可以管理直接进行检查的患者流量，或为转诊临床医生提供临床建议，而无需进行面对面评估。
我们审查了 12 个月内 809 例（692 例女性；117 例男性）转介至骨质疏松专科服务的电子分诊结果（平均年龄 65±16.5 岁）。转诊临床医生和专科服务之间对分诊类别有很高的一致性（741/809）。73.3%的患者在顾问主导的诊所进行了面对面就诊，而积极的分诊使 18.4%的患者能够直接进行检查，8.3%的患者可以出院。在 12 个月期间，从收到电子转介到电子分诊的平均时间为 3 天，而在不包括年假期间时，平均时间为 2.1 天（中位数为 1.1 天）。
电子分诊支持在繁忙的骨质疏松症服务中进行有效的转介管理。效率受到目前仅依赖一名临床医生和 5 天工作制的限制。通过多学科团队合作、虚拟诊所和未来信息技术的发展，系统访问还有进一步改善的空间。
