RightPath: a new model of care for children and young people
RightPath is a novel model of care to triage children and young people with musculoskeletal presentations in the community; the aim is to facilitate referral to the appropriate clinicians - either referral to hospital based care or to community based clinicians.
Implementation
RightPath is a model of care within existing primary care or community based services. The Triage guidance covers common musculoskeletal presentations with a checklist to indicate if referral to hospital based specialist care is needed or not. The Triage guidance is primarily focused around lower limb presentations and pathology. Concerns regarding the upper limb, including pain, asymmetry or weakness should be referred to specialist services in accordance with local pathways. Triage is ideally performed by paediatric physiotherapists and knowledge of normal musculoskeletal development is essential. Triage staff need ongoing support and training: case based peer to peer discussions work well and more so with an experienced colleague as a 'go-to' resource.
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Education and Support
Staff involved in triage greatly value and benefit from sharing experiences and learning from each other. Case based discussions with peer support and access to an experienced clinician are ideal. Audit data and regular feedback about triage outcomes work well. Self directed learning is to be encouraged with open access to Paediatric Musculoskeletal Matters.
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Evaluation
Triage teams value feedback to enable growth of confidence and their performance. Audit data of referrals and diagnostic codes following triage inform learning. Satisfaction questionnaires provide feedback from parents and children. Logs of activity completed by physiotherapists and podiatrists inform triage evaluation and educational needs for training complete.
Find Out MoreWhat is RightPath ?
Musculoskeletal presentations to primary care amongst children & young people are common. In most cases the underlying cause is not serious; explanation, advice and reassurance will often suffice and referral to specialist hospital-based care is not necessary. However, serious illness may be the underlying cause and it is important that those with potentially serious illness are identified and referred on quickly.
The aim of RightPath is to provide rapid triage and facilitate referral to the 'right care for the right child in the right place'.
RightPath is a model of care where children and young people with musculoskeletal complaints can be assessed in the community using triage guidance and expertise of paediatric physiotherapists. Those with potential serious illness are identified and referred promptly to hospital-based specialist care (orthopaedics or rheumatology or neurology or general paediatrics) pending the suspected diagnosis. Those deemed to have a non-serious disease are managed in the community by physiotherapists and/or podiatrists.
RightPath has been piloted in two separate sites in England, UK. The pilot was completed in 2018 and essentially demonstrated that the model of care is feasible, safe and acceptable to families and clinicians involved (publication in progress following peer review).
The project was funded by Oldham Clinical Commissioning Group and an unrestricted educational bursary from Pfizer. This included funding to evaluate the impact of the intervention and the evaluation focus of the project was led by Newcastle University. The project was National Institute for Health Research (NIHR) portfolio adopted and Research infrastructure support was provided by the North East and North Cumbria Clinical Research Network (NENC CRN).
RightPath was awarded the British Society for Rheumatology (BSR) Best Practice award 2018.
