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Referring wisely: orthopedic referral guidelines at an academic institution
Maria E Otto1, Carlin Senter, Ralph Gonzales
1University of California, San Francisco, 1701 Divisadero St, Ste 500, San Francisco, CA 94143.
Objectives:
To develop local orthopedic guidelines for use in referral decision support and electronic consultation programs at University of California, San Francisco Health.
Study Design:
Modified Delphi method.
Methods:
We performed a 2-phase modified Delphi study to identify consensus between primary care and orthopedic clinicians for common musculoskeletal problems.
Results:
Clinicians agreed that confirming patient interest in an orthopedic procedure should be completed prior to referral in 81% of clinical scenarios, as well as conservative management in 80%, physical therapy in 60%, and x-ray prior to referral in 42% of scenarios. Clinicians agreed an MRI should not be performed prior to referral in most (58%) clinical scenarios.
Conclusions:
In the absence of national guidelines, a process for local guideline generation is needed in order to provide nuanced and detailed decision support at the point of referral. The Delphi method proved an effective process to achieve this end.
