Dr. Don Johnson: Is there an effective method to triage patients who are referred to orthopedists?
Dr. Cy Frank: Yes, we have demonstrated that it is possible in Canada to create a limited central referral service, but it will take some time to work with primary care networks and/or individuals to develop the appropriate comprehensive triage tools to build a better bridge from the primary care referral to the orthopedic specialist. Subspecialists need clear referral criteria and templates with transparent criteria of how to get to them. Engaging other musculoskeletal–interested disciplines in nonsurgical management is equally critical to potentially decrease the morbidity of delayed or misdiagnoses. Getting “the right patient to the right place at the right time, the first time, every time, should be the goal” of the triage system and the team. Effective and knowledgeable multidisciplinary ‘front-end’ triage is the secret.
Present, future orthopedic care models in Canada focus on increasing efficiency, Orthopedics Today, June 2008
Why Primary Care Physiotherapy?
There are serious and costly consequences to delayed, inappropriate or inadequate musculoskeletal care that not only impact patients but also healthcare professionals and provincial health systems.
The consequences include;
- Increased risk permanent disability
- Increased risk of chronic pain
- Increased dependency on prescription pain medications
- Increased support burden on families and social services
- Increased stress and workload on family physicians
- Increased healthcare costs
- Increased wait times and waiting lists
Without access to an orthopaedic triage assessment by a local physiotherapist, many family physicians have very few options to deliver the standard of care and are left to depend on prescription pain medications, ordering premature and inappropriate MRIs as well as writing premature and inappropriate surgical referrals.
This missing link is a orthopaedic triage assessment by an experienced orthopaedic physiotherapist. Research conducted University of British Columbia showed that experienced orthopaedic physiotherapists were four times better than family physicians and emergency room physicians in identifying patients requiring surgery AND that a physiotherapist based triage system could reduce wait lists by 75%.
The Primary Care Physio program is designed to support family physicians in providing front line triage assessments and ensuring patients get on the right clinical pathway for their condition as soon as possible.
The Primary Care Physio program was developed by one of Canada’s most experienced orthopaedic physiotherapists and the founder / owner of the OrthopaedicsCanada.com Network, Terry Kane (Calgary). To learn more about Terry Kane visit www.terrykane.ca
IMPORTANT: The Primary Care Physio Program does NOT involve or endorse the use of passive treatment methods such as electromodalities, joint manipulations, manual therapy, acupuncture or needling – the program is strictly 100% – education and exercise based.
“Subspecialists need clear referral criteria and templates with transparent criteria of how to get to them. Engaging other musculoskeletal–interested disciplines in nonsurgical management is equally critical to potentially decrease the morbidity of delayed or misdiagnoses.” – Dr. Cy Frank
Orthopaedic Triage Assessments are designed to:
- Obtain a valid and reliable clinical diagnosis / impression by an experienced orthopaedic physiotherapist.
- To provide clinical direction to referring family physicians on the most appropriate clinical pathway for their patient(s).
- Educate patients on their condition, prognosis, self-management strategies and the importance of safe and appropriate physical activity to optimizing their joint function and avoiding permanent pain and disability.
- To empower and engage patients in home-based rehab exercises as the top priority in preserving their joint function.
- To provide supporting documentation in the form of a letter to an orthopaedic surgeon IF (1) a patient has executed a self-management and home-based exercise program for three months without improvement in their joint function and (2) the patient meets the medical criteria for a surgical consult for a known surgical procedure.
What is Primary Care Physiotherapy?
Primary Care Physiotherapy is designed to support family physicians in providing front line triage assessments and ensuring patients get on the right clinical pathway for their condition as soon as possible. In other words, getting patients to the right place at the right time, every time.
Primary Care Physiotherapy is not intended to duplicate community physiotherapy, but is intended to help family physicians by providing on-site collaborative triage assessments, patient education on self-management and home based rehab exercise programs. Additional services include collaboration on evidence-based diagnostic imaging and appropriate surgical and specialist referrals.
The emphasis of primary care physiotherapy isn’t to create dependence on passive treatments but rather to create independence and increased physical activity – this is achieved by capping the number of appointments.
Primary Care Physiotherapy Services.
- In-house referrals to a experienced primary care physiotherapist.
- Easy access for patients in their family physician’s office (aka “medical home”)
- Collaborative on-site physician-physiotherapist consults.
- Enhanced frontline MSK / Orthopaedic triaging onto the right clinical pathway.
- Emphasis on patient education on self-management strategies and engaging patients in home-based exercise.
- Appropriate referrals to community services as indicated.
- Integration of clinical notes into primary care EMRs
If you’re interested in learning more, please contact me directly by phone at 403-714-7617 or by email at email@example.com.
Thank you for your time.
Terry Kane, Registered Physiotherapist.
About Terry Kane
Terry Kane is one of Canada’s most experienced orthopaedic physiotherapists with over 30 years of clinical experience and the owner and founder of Canada’s only national online Orthopaedic Network – OrthopaedicsCanada.com.
Since 1985, Terry has worked with some of the top orthopaedic surgeons, sports medicine physicians and chronic pain specialists in Canada and the United States. A graduate of the University of Toronto, former Canadian Olympic Hockey Team and Calgary Flames physiotherapist, Terry has over 30 years of clinical experience in diagnosing and designing evidenced based rehab programs for thousands of orthopaedic patients, including over 500 Olympic and professional athletes.
In addition, Terry has worked at the University of Calgary Sports Medicine Centre, the Calgary Chronic Pain Centre, provided primary care physiotherapy services for Calgary West Central Primary Care Network as well as the Fourth Street Clinic (members of Calgary West Central PCN).
Terry Kane’s Professional Experiences
- Served as Head Physical Therapist for the Calgary Flames and Canada’s Olympic Men’s Ice Hockey Team,
- Lectured internationally on exercise based rehabilitation for over twenty years (i.e. American College of Sports Medicine, etc)
- Lectured on physical therapy for the University of Calgary Department of Orthopaedics as well as Department of Continuing Medical Education.
- Served as Injury Analysis Consultant to the National Hockey League’s Injury Analysis Panel.
- Served as a contributing developer & instructor of a MainPro-C Course on “Chronic Pain for Family Physicians” for the University of Calgary Department of Continuing Medical Education.
- Served as a contributing author “Foundations of Personal Training”: Human Kinetics, 2008 (ISBN-13:9781450441322)
- Served as editorial peer reviewer for the Physician and Sportsmedicine, the Clinical Journal of Sports Medicine and Pain Research and Management Journal.
- Served a volunteer member of Alberta’s Bone and Joint Strategic Clinical Network Committee.
Terry Kane’s Professional Goals
To improve the standard of clinical diagnostics, triaging and evidence-based bone and joint care in primary care practices through a collaborative and integrated model of primary care physiotherapy. .
To deliver the highest standard of evidence-based physical therapy on behalf of patients, referring physicians and orthopaedic surgeons.
To improve the standard of care in the multidisciplinary management of musculoskeletal conditions in Canada through improved orthopaedic triaging and adoption of evidence-based clinical care pathways.
To leverage web-based technologies to improve the standard of evidence-based care among healthcare professionals in the non-surgical management of musculoskeletal conditions as well as post-surgical rehabilitation.
To leverage web-based technologies to improve public awareness of evidence-based clinical pathways in the management of musculoskeletal conditions and prevention of chronic pain.
Career Path | Background
- Physical Therapist, Terry Kane Physical Therapy (1985 – present)
- Physical Therapist, Fourth Street Clinic Primary Care Clinic (2016 – present)
- Physical Therapist, Calgary West Central Primary Care Network ( August 2014 – March 2016)
- Founder, Owner, OrthopaedicsCanada.com Network (2008 – present)
- Founder, Owner, OrthopaedicProtocols.com (2008 – present)
- Physical Therapist, Copeman Healthcare, (2008 – 2011)
- Physical Therapist, Alberta Health Services, Calgary Chronic Pain Centre (2005 – 2008)
- Injury Analysis Consultant, National Hockey League (2000-2004)
- Physical Therapist, Calgary Flames (1995 – 2001)
- Owner, Physical Therapist, Achilles Physiotherapy Clinic (1993 – 1995)
- Physical Therapist, University of Calgary Sports Medicine Centre, (1990 – 1993)
- Physical Therapist, McMahon Stadium Sports Physiotherapy Clinic (1988 – 1990)
- Physical Therapist, Canadian Men’s Olympic Hockey Team (1985 – 1988)
- University of Toronto, Bachelor of Sciences (Physical Therapy) (1982-1985)
- University of Toronto, Bachelor of Physical and Health Education (1977-1981)