Improving Safety, Efficiency, Cost, and Satisfaction Across a Musculoskeletal Pathway Using the Digital Assessment Routing Tool for Triage: Quality Improvement Study.

backgroundMusculoskeletal (MSK) conditions are prevalent and increasing in Western-style economies, associated with an aging population and reduced physical activity levels. Prevention, early detection, and treatment can enable people to live in good health, remain independent and socially connected, and have economic advantages for society, such as reducing pressure on health and social care services. Triaging patients safely and effectively to the right care, for the first time improves outcomes and reduces costs, with digital solutions offering potential advantages over traditional methods.

objectiveWe evaluated the impact of introducing a digital assessment routing tool (DART) on safety, efficiency, cost, and satisfaction across a National Health Service (NHS) England MSK service.

methodsWe designed a quality improvement study using a Plan-Do-Study-Act design and Integrated Knowledge Translation model, with DART as the first point of contact for self-referring patients with MSK conditions. Patients completed a web-based DART assessment independently, or with administrative telephone support. The primary safety outcome was measured by agreement between clinician judgment and safety incident surveillance. Quantitative and qualitative methods were used to measure secondary outcomes of efficiency, cost, and satisfaction. Analysis was completed collaboratively between researchers and the NHS service team with reference to 4 months of prestudy data. Three consecutive study cycles were completed over a 4-month period between February and May 2024 with 4076 self-referring patients between the ages of 16-104 (mean 59) years.

resultsNinety-three percent of patients self-assessed using DART with the remainder assisted by an administrator. All predefined outcome targets were met for all measures. Agreement between clinicians and DART was 96%, no safety incidents occurred, there was immediate stratification of 401 (9.8%) urgent cases, and 203 fewer cases requiring clinical escalation following initial clinician contact. Administrative time to process self-referrals was reduced by 51% with a cost saving of £80.16 (US $101.30) per 100 referrals. Introduction of a new route to self-management for less complex conditions showed a cost reduction per patient of 73%, giving a saving of £1272.90 (US $1605.56) for 100 referrals. Routing to a new osteoarthritis knee program would reduce costs for these patients by 63%, equating to £220.35 (US $278.46), if implemented. Further potential savings of £28,476 (US $37,320)/annum could be realized using DART to screen for service eligibility criteria. Patient satisfaction was consistent throughout the study, with a mean of 90%. Service administrators and clinicians rated the new process as a positive service improvement.

conclusionsThe introduction of DART demonstrated positive outcomes in all measures and presented opportunities to improve safety and efficiency, reduce cost, and improve patient and clinician satisfaction across an NHS MSK pathway. In addition, the successful delivery of an Integrated Knowledge Translation Approach showed the benefits of collaborative working between researchers, clinicians, and other service staff.