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Improving the Accuracy and Timeliness of Referral Triage for Patients with Lower Back Pain Referred to an Academic Medical Center’s Spine Center

Background: University Medical Center’s (UMC) current triage mechanism for adults with lumbar spine problems frequently triages patients to the wrong spine specialist with the wrong timing leading to decreased access and patient satisfaction. Purpose: This quality improvement (QI) project sought to improve the triage accuracy of referrals for adults with lumbar spine issues by implementing triage performed by a Nurse Practitioner (NP). NP based triage is an evidence-based practice to improve triage accuracy and increase access and patient satisfaction. Methods: The NP triaged 95 incoming referrals for patients 18 years and older with lumbar spine problems using established triage guidelines by UMC and the Spine Severity Index. After the patient was seen by a spine specialist, agreement with the triage decision was assessed by surveying the provider. Wait times were measured during the NP led triage project. Spine specialist feedback was collected on 95 triaged patients. Concordance was measured using percentage agreement. Patient satisfaction scores were collected by a hospital-based survey system during the QI project. Results: The NP triage mechanism had a concordance score of 92.50% and the decision tree had a score of 63.04%. A Mann-Whitney U test revealed a statistically significant difference between the two triage mechanisms (Mann-Whitney U=1438.00, pConclusion:NP triage leads to more accurate triage than the decision tree method but did not have observed secondary effect on wait times or patient satisfaction. This is likely due to provider attrition and the COVID-19 pandemic.