Abstract
Orthopaedic elective surgery clinics have long unmonitored wait times. Advanced physiotherapists have the skills needed to filter those patients in most urgent need of surgical consultation. We aimed to improve the efficiency and patient outcomes of these clinics.
A project was conducted using a knowledge translation framework from 2022 to 2024 to investigate the barriers and implement best practice care for patients with knee osteoarthritis referred to a surgical clinic. Interviews with stakeholders informed barriers and enablers to applying best practice models of care, and service statistics over three years were analysed to inform decisions and conduct economic analysis.
We found that anchoring in the clinical care standard, increasing screening by advanced practice physiotherapists and facilitating access to community-based nonsurgical interventions significantly reduced waiting times to see a surgeon and directed patients to appropriate care pathways.
Background: Lengthy wait times between GP referral and specialist consultation harm vulnerable patients. Advanced physiotherapy (AP) practitioners have shown diagnostic and triage concordance with orthopaedic surgeons and high patient satisfaction.
Aim: To sustainably reduce the wait time between GP referral and consultation in orthopaedic clinics.
Methods: Knowledge translation involves stakeholders in identifying best practices, barriers, enablers, and data collection to evaluate impact, ensuring sustainability and ownership of change. Our steering committee included internal and external stakeholders from public and private health sectors and consumers. In 2023, AP screening was increased for all knee osteoarthritis patients, health records became digital, and hip and knee programs expanded in community health centres.
Service Data: We analysed patient characteristics, wait times, and pathways for orthopaedic patients with knee osteoarthritis referred between March and September in 2022, 2023, and 2024 and examined factors predicting longer waits.
Stakeholder Voices: We interviewed stakeholders including six patients waiting to see a surgeon, four surgeons, five health executives, six health professionals, and six primary care practitioners. We asked what was working well, what was not, what an excellent model of care would look like, and the barriers and enablers. Thematic analysis was framed by these research questions.
Results: Screening increased to 21%, 81%, and 74% of patients in 2022, 2023, and 2024, respectively. The wait to consultation was 800 days (mean, range 6-1935) in 2022. In 2023 and 2024, all patients except the most severe were screened (wait time to screening: 50 days in 2023 and 55 days in 2024). This resulted in reduced wait times to see a surgeon for category 2 patients: from 193 days (7-1983) in 2022 to 82 days (12-175) in 2023 and 63 days in 2024.
AP screening resulted in surgeons saw 77% of new patients in 2022, but this decreased to 56% in 2023 and 53% in 2024. Surgeons discharged 27% of patients at the initial consultation in 2022, but with increased screening, this dropped to 10% in 2023 and 21% in 2024.
Stakeholders valued AP screening: patients appreciated advice and surgeons appreciated the filtering of patients. While the quality of surgery was appreciated, waits were deemed unacceptably long, especially for complex patients at risk of deterioration. The preferred model of care was a community-based program providing assessment, advice, and review with rapid access to surgery when needed. APs working at the top of their scope have these skills. Mechanisms to escalate deteriorating patients were needed. AP’s sought access to imaging, direct referral to the orthopaedic list, and quick access to surgeon advice. Good communication with the community to promote allied health interventions before considering surgery was essential. Facilitating access to surgery for the right patients was crucial for a responsive, efficient system.
Implications: AP physiotherapy consultations provide quality care and streamline access to surgical and non-surgical care. The impact included faster access to surgeon consultations with shorter wait times and greater uptake of non-surgical options. The data collected will enable ongoing monitoring to maintain system efficiency.
A project was conducted using a knowledge translation framework from 2022 to 2024 to investigate the barriers and implement best practice care for patients with knee osteoarthritis referred to a surgical clinic. Interviews with stakeholders informed barriers and enablers to applying best practice models of care, and service statistics over three years were analysed to inform decisions and conduct economic analysis.
We found that anchoring in the clinical care standard, increasing screening by advanced practice physiotherapists and facilitating access to community-based nonsurgical interventions significantly reduced waiting times to see a surgeon and directed patients to appropriate care pathways.
Background: Lengthy wait times between GP referral and specialist consultation harm vulnerable patients. Advanced physiotherapy (AP) practitioners have shown diagnostic and triage concordance with orthopaedic surgeons and high patient satisfaction.
Aim: To sustainably reduce the wait time between GP referral and consultation in orthopaedic clinics.
Methods: Knowledge translation involves stakeholders in identifying best practices, barriers, enablers, and data collection to evaluate impact, ensuring sustainability and ownership of change. Our steering committee included internal and external stakeholders from public and private health sectors and consumers. In 2023, AP screening was increased for all knee osteoarthritis patients, health records became digital, and hip and knee programs expanded in community health centres.
Service Data: We analysed patient characteristics, wait times, and pathways for orthopaedic patients with knee osteoarthritis referred between March and September in 2022, 2023, and 2024 and examined factors predicting longer waits.
Stakeholder Voices: We interviewed stakeholders including six patients waiting to see a surgeon, four surgeons, five health executives, six health professionals, and six primary care practitioners. We asked what was working well, what was not, what an excellent model of care would look like, and the barriers and enablers. Thematic analysis was framed by these research questions.
Results: Screening increased to 21%, 81%, and 74% of patients in 2022, 2023, and 2024, respectively. The wait to consultation was 800 days (mean, range 6-1935) in 2022. In 2023 and 2024, all patients except the most severe were screened (wait time to screening: 50 days in 2023 and 55 days in 2024). This resulted in reduced wait times to see a surgeon for category 2 patients: from 193 days (7-1983) in 2022 to 82 days (12-175) in 2023 and 63 days in 2024.
AP screening resulted in surgeons saw 77% of new patients in 2022, but this decreased to 56% in 2023 and 53% in 2024. Surgeons discharged 27% of patients at the initial consultation in 2022, but with increased screening, this dropped to 10% in 2023 and 21% in 2024.
Stakeholders valued AP screening: patients appreciated advice and surgeons appreciated the filtering of patients. While the quality of surgery was appreciated, waits were deemed unacceptably long, especially for complex patients at risk of deterioration. The preferred model of care was a community-based program providing assessment, advice, and review with rapid access to surgery when needed. APs working at the top of their scope have these skills. Mechanisms to escalate deteriorating patients were needed. AP’s sought access to imaging, direct referral to the orthopaedic list, and quick access to surgeon advice. Good communication with the community to promote allied health interventions before considering surgery was essential. Facilitating access to surgery for the right patients was crucial for a responsive, efficient system.
Implications: AP physiotherapy consultations provide quality care and streamline access to surgical and non-surgical care. The impact included faster access to surgeon consultations with shorter wait times and greater uptake of non-surgical options. The data collected will enable ongoing monitoring to maintain system efficiency.
| Original language | English |
|---|---|
| Pages | 1-31 |
| Number of pages | 31 |
| Publication status | Published - 20 Nov 2025 |
| Event | BMJ Quality and Safety in Healthcare - Canberra, Australia Duration: 19 Nov 2025 → 21 Nov 2025 |
Conference
| Conference | BMJ Quality and Safety in Healthcare |
|---|---|
| Country/Territory | Australia |
| City | Canberra |
| Period | 19/11/25 → 21/11/25 |