Musculoskeletal Triage Service

Many patients referred to orthopaedic and rheumatology services do not need to see a consultant but instead need timely expert assessment, reassurance, and help to manage and improve their condition. The musculoskeletal triage service is run by a team of clinical specialist physiotherapists with advanced training in assessment and treatment. The team see new, appropriately triaged orthopaedic and rheumatology patients. Currently over 80% of patients referred to this service are seen within three months of referral.

Fig.1: MSK Triage pathway

When a patient is seen promptly, it is often easier to assist them in improving their situation. The longer a person is living with pain the more complex the issue can become. It is normal to adapt movement patterns to avoid pain, it is normal to become worried about the reason for your pain and how long it might last, it is normal to stop or avoid certain activities for fear of doing more damage to yourself. However, this is frequently not the most helpful way of managing pain or injuries. When people understand the reason for their pain, they are then better able to manage it without fear of making it worse.

Communication

One of the key strengths of the MSK Triage service is our effective communication. We are in regular contact with consultants, GPs and treating physiotherapists while offering patients sufficient time to fully explain their condition and agree the best management plan for them. Over the past two years, we have set up outreach clinics in Inchicore, Ballyfermot and St Josephs’ Primary Care Centres alongside our community colleagues. This allows patients to be seen closer to home in a quieter environment. Patients report a very high level of satisfaction with this service and its locations.

Pain Pathway

We have also developed a virtual pain clinic pathway. This enables us to collaborate with the pain service consultants to discuss patient care pathways and effectively direct the right patients to receive treatment. It maximises use of clinical time, avoiding duplicate assessment and reducing the number of appointments the patient has to attend. We also run an injection clinic under one orthopaedic consultant to help manage patients’ pain with selective use of corticosteroid joint and soft-tissue injections and early rehabilitation.

Developments for 2025

We were very fortunate to secure Service Improvement Programme (SIP) funding for an additional post in MSK triage for 2024, allowing us to dramatically reduce waiting time for the service in 2024. At the end of 2024, nearly all patients were seen within three months of referral to the service in comparison to 30% at the end of 2023. We are hopeful that we will be able to secure funding for 2025, which will allow us to maintain our goal of seeing patients within three months of referral. The additional staffing would also enable us to further develop the service and allow us to offer advanced, expedited care to our patients.

Fig 2: MSK Triage team

One such advancement is the ability for the physiotherapists in our service to request medical imaging. Two of our clinical specialists have completed the Professional Certificate Referring for Radiological Procedures and pending the anticipated change in legislation in February or March 2025, will be able to order imaging when needed without the need to request this from medical colleagues. Developments in this service allow patients to be seen in a timely fashion, reduce the duration of pain and disability for patients and ensure communication happens in a more integrated fashion. We look forward to further advancements in 2025!