E037 Which clinicians are best placed to undertake rheumatology triage?

Abstract Background/Aims Rheumatology outpatient triage guidelines have been published by the British Society for Rheumatology to support best use of rheumatology resources. In our department (providing secondary and tertiary rheumatology services), triage has been undertaken by community-based advanced practice physiotherapists (APP) with guidance from consultant rheumatologists (CR) for the past ten years. We aimed to compare triage decisions between the current triage team of APPs and CRs. Methods In addition to the APP routine daily triage (first triage), a CR was assigned randomly to perform a second triage for five consecutive days. APP and CR were blinded to each other’s triage decisions. Independent comparison of the triage decisions was conducted by the first author (WG) using an arbitrary six-point Likert scale rating the agreement of triage decisions: complete agreement (100%) to total disagreement (0%), with partial ratings of 20%, 40%, 60% and 80%, depending on the referral urgency and the explanation of triage decisions. Triage agreement decisions between 0-80% were discussed with the last author (AL) and agreement score amended, if indicated. Results Forty-seven referrals were received (Table). There was a high level of agreement of triage decisions: 35/47 (74%) complete agreement between APP and CR. 7/47 (15%) were adjudged to have 80% agreement: both groups agreed the patient needed to be seen but differed on the urgency (suspected EIA appointment within 3 weeks versus urgent appointment within 6 weeks). APPs applied suspected EIA triage criteria more strictly than CR. For the remaining 5 referrals, the disagreement was due to the APPs’ tendency to accept referrals that the CR rejected as non-inflammatory. Conclusion The current triaging team are 89% in agreement overall with CR. Where disagreements occurred, simple changes to the triage criteria, education and feedback should improve the triaging undertaken by APPs. Delegating triage to the APP team in our department is appropriate (caveat: our APP team have been triaging for 10 years, using long-term experience and knowledge), thus saving CRs time to undertake consultant-specific clinical roles. Discussion within the wider department regarding knowledge and signposting of services for non-inflammatory conditions is underway. Disclosure W.J. Gregory: None. S. Ayub: None. P. Barratt: None. H. Chinoy: None. J. Clarke: None. R. Harris: None. B. Harrison: None. S. Kamath: None. A. Reading: None. A. Low: None.