Development of a referral triage system for determining access to a public hospital rheumatology service

ARA Scientific Posters, Australian Rheumatology Association-Rheumatology Health Professionals Association 55th Annual Scientific Meeting, Hobart, Australia, Internal Medicine Journal 44 (suppl S2), 10-37

D White (1), R Naden (2), A Doube (1), K Solanki (1), V Quincey (1), S Sawyers (3), T Kain (4), G Tam (5), A Minnett (6), I Gilbertson (7), G Al Aranji (1), W Chang (1)

(1) Waikato DHB, (2) Auckland DHB, (3) Hawkes Bay DHB, (4) Bay of Plenty DHB, (5) Midland PHO, (6) Matamata Medical Centre, (7) Leamington Medical Centre, New Zealand

Aim: In many countries, including New Zealand, the demand for rheumatology services exceeds their supply meaning that some experience long delays or are not seen at all. The principal objective of this work was to create a validated, transparent and fair system for determining access to rheumatology services.

Methods: A panel of six rheumatologists, six primary care physicians and four nurse specialists ranked a series of 25 clinical scenarios in order of priority to see a rheumatologist. Important determining factors were weighted in an iterative process to generate a multi-dimensional additive points score. Software form 1000minds was used to gather and analyze data.

Results: A multi-dimensional additive points scoring system incorporating domains reflecting the severity of the problem on the patient's life, risk for progression and how much benefit was to be gained from rheumatology assessment were included.

Conclusions: A multi-dimensional additive points system for determining access to a rheumatology service has been developed and is currently undergoing evaluation in practice. The system has face validity and has been incorporated in to the primary care referral process to provide the mandatory information required for each referral.