LAUSR

Introduction Juvenile idiopathic Arthritis (JIA) is the most common inflammatory disorder of childhood. Early recognition and optimal treatment of JIA is associated with reduced mortality and morbidity. Wait times for new patients to be reviewed by paediatric rheumatologists in Ireland are significantly outside the Standards of Care for children and young people with JIA (2010). These recommend that patients with suspected JIA be seen by a paediatric rheumatologist within 42 days of the referral being made. Advanced practice physiotherapist (APP) provided triage clinics have successfully reduced waiting lists and provided intermediate care pathways for patients who do not necessarily require rheumatologist review (Stanhope et al., 2012). This service model may be an option to manage waiting lists. New referrals to the paediatric rheumatology are triaged by rheumatologists based on the information provided in the paper referral as ‘urgent’, ‘soon’ and ‘routine’ as per clinical indications. Those referrals categorised as urgent require consultant review, however it may be possible for referrals in the ‘routine’ and ‘soon’ categories to be reviewed by an APP. Method The active waiting list for new referrals categorised as ‘soon’ and ‘routine’ were audited in July 2018 to identify the characteristics of referrals and determine the number of referrals that would be appropriate for an APP clinic. Referrals for a musculoskeletal (MSK) presentation were deemed appropriate for APP clinic where; it appears likely to be a non-inflammatory source of the MSK issue; is it was not clear from the paper referral whether an inflammatory joint condition is the source of MSK issue; there is no indication of connective tissue disorder, specific rheumatologic disorder, unexplained and/or significant co-morbid medical symptoms, nor of complex neuro-disability history. Results There are 421 and 437 children in total on the ‘routine’ and ‘soon’ waiting lists respectively. These children are waiting on average 631 and 592 days, and the longest wait is 1550 and 1516 days on the ‘routine’ and ‘soon’ waiting lists respectively. Review of the diagnosis provided on the referral indicates that 89% on the ‘routine’ waiting list and 65% on the ‘soon’ list are appropriate for APP triage. Conclusion An APP triage clinic is feasible to help manage the waiting list for paediatric rheumatology. The implementation of an APP triage clinic can ensure that only those referrals that require a consultant review are seen at consultant clinic. All others may be successfully managed by an APP.