SH12: SELF ADMINISTERED SHOULDER ASSESSMENT FORM – IS IT RELIABLE AS A TRIAGE TOOL IN OUTPATIENT SETTING?

Abstract

Introduction: Mismatch between patient load and out-patient clinic resources in South Australian public sector has resulted in a long waiting list for initial appointment of new patients with shoulder complaints. There is no validated triage tool to help prioritize the patient referrals appropriately, to avoid inappropriate delays.

Methods: We devised a self evaluation questionnaire to appropriately triage new referrals with shoulder complaints. Ethics committee approval was obtained. Forty eight new referrals to shoulder clinic filled in this questionnaire and the self evaluation part of American Shoulder and Elbow Society form. The patients were assessed in chronological order by two surgeons. Both were blinded to the GP referral and questionnaire findings at the time of patient assessment. GP referrals and the questionnaires were subsequently assessed and triaged. These findings were compared to assessment in the clinic.

Results: Whilst the questionnaire provided significantly more information when compared to GP referrals, both were inadequate on their own as reliable triage tool. However in combination, majority of the patients could be triaged appropriately. Based on the presumptive diagnosis, basic investigations and therapy can be correctly instituted whilst awaiting formal orthopaedic review. None of the patients would have been allocated a lower priority than appropriate. The self evaluation part of ASES form on its own was not a satisfactory tool for triaging.

Discussion: The proposed questionnaire and initial referral letter can be used for safe triaging and ensuring most basic relevant clinical workup is done prior to presentation. Further refinement of the questionnaire and additional studies are required to fully define its role in routine public hospital use.