Improving safety, efficiency, cost, and satisfaction across a musculoskeletal pathway using the Digital Assessment Routing tool for triage: a quality improvement study. (Preprint)

Abstract

BACKGROUND The increasing prevalence of musculoskeletal conditions results in an increasing financial burden to societies and healthcare systems. Triaging patients safely and effectively improves outcomes and reduces costs across the pathway, with digital solutions offering potential advantages over traditional methods. OBJECTIVE We aimed to examine the impact of introducing DART (Digital Assessment Routing Tool) on safety, efficiency, cost and satisfaction across a National Health Service England musculoskeletal service. METHODS A quality improvement project utilizing a Plan-Do-Study-Act design and Integrated Knowledge Translation model. All musculoskeletal self-referring patients completed an online DART assessment independently, or with administrative telephone support. Quantitative and qualitative methods evaluated the primary outcome of safety, indicated both by agreement between clinician judgement and DART stratification, and safety incident surveillance. Secondary outcomes included efficiency, cost and satisfaction. RESULTS Over 4 months 4076 patients self-referred, 93% self-assessing using DART and the remainder via an administrator. Agreement between clinicians and DART was 96%, no safety incidents occurred, and 203 fewer cases required clinical escalation at initial clinician contact compared to the pre-project period. Administrative time to process self-referrals reduced by 83% with a projected £15,312 (US$20,067)/annum cost-saving. Routing to self-management and an osteoarthritis knee program would reduce costs by £79,590 (US$104,310)/annum when implemented. Further potential savings of £28,476 (US$37,320)/annum were demonstrated by DART screening for service eligibility criteria. Patient satisfaction was 90%, with all 14 administrators and 40 clinicians rating the introduction of DART as a positive service improvement. CONCLUSIONS The introduction of DART demonstrated positive outcomes in all measures presenting opportunities to improve safety and efficiency, reduce cost and improve patient and clinician satisfaction. In addition, the successful delivery of an Integrated Knowledge Translation Approach provides a model for other researchers wishing to test and implement digital health within a musculoskeletal service.