Surgical and radiological referral rates
St Sampson’s Medical Centre, St Sampson’s, Guernsey, UK, and
Sharon Morgans and Cathy Barrett
St Mary’s NHS Trust, London, UK
Purpose – The purpose of this paper is to discuss the scepticism that persists among medics
regarding appropriateness of some aspects of services provided by extended scope physiotherapists
(ESPs). This paper aims to highlight the extent and appropriateness of surgical and radiological
referrals by ESPs working in an adult orthopaedic service.
Design/methodology/approach – The patient pathway following ESP assessment was audited
over 31 months. Parameters explored included ESP referral rates to orthopaedic consultants; the
percentage of patients where the entire episode of care was managed by the ESP; whether orthopaedic
referrals were appropriate in terms of surgical interventions; and numbers of radiology referrals
speciﬁcally for knee or lumbar complaints.
Findings – Of the patients, 79 per cent had their entire episode of care managed by ESPs. Of the
patients, 9 per cent were referred on for a surgical opinion (of which 42 per cent knees, 20 per cent
lumbar). 13 per cent were referred for x-rays, 10 per cent for magnetic resonance imaging. Of the
patients referred on for surgical opinion surgical intervention was appropriate in 89 per cent of cases.
Research limitations/implications – Data from an ESP service with broad guiding protocols in a
speciﬁc hospital are not readily extrapolated to ESPs elsewhere. Appropriateness of onwards referrals
was based on the opinions of consultants to whom patients were referred. The potential beneﬁt of a
second opinion even if surgery is not offered is not taken into account by this model.
Practical implications – These audits reinforce the impact ESPs have on efﬁciency within
orthopaedics. They document referral rates for x-rays and magnetic resonance imaging by ESPs for
lumbar and knee complaints that may beneﬁt units proposing new ESP services.
Originality/value – This paper reinforces published data on ESP management of the entire episode
of care of the majority of referrals to orthopaedics, and on the highly appropriate nature of onwards
referrals. Documented for possibly the ﬁrst time, data regarding investigations for lumbar and knee
disorders highlight low referral rates.
Keywords Orthopaedics, Radiology, Physiotherapy, Auditing
Paper type Research paper
It is estimated that 34-43 per cent of general practitioner referrals to orthopaedic
departments do not need to be managed by a surgeon (Elwyn and Stott, 1994; Roland
et al., 1991). In a climate of high demand for orthopaedic services this obviously places
unnecessary stresses on already overburdened orthopaedic clinics. To address these
excessive burdens placed on services traditionally provided by medical staff the
Secretary of State for Health (2000) suggested that “To reduce waiting times and deliver
modern, patient-centred services” therapists must take on “a wider range of clinical
The current issue and full text archive of this journal is available at
Received January 2008
Revised August 2008
Accepted August 2008
Clinical Governance: An International
Vol. 14 No. 1, 2009
q Emerald Group Publishing Limited