Using the modified Hand Injury Severity Score (mHISS) as an objective measure to evaluate a mechanism of triage in a hand therapy department

Abstract

Introduction

Outpatient departments triage their patients to clinicians with the correct skills and experience to ensure an optimal outcome. Currently this is done through experience of senior clinicians, and varies from one hand therapy department to another. We wished to see if the modified Hand Injury Severity Score a (mHISSa) could be used as an objective tool to triage these patients.

Methods

The mHISS was adapted slightly, and became the mHISSa for this study. Two hundred patient referrals, of previously discharged patients, were reviewed. The grade of staff that had treated them was noted and the referral was scored against the mHISSa. This was used to determine if there was correlation between the score and the current triage pattern.

Results

We found a strong association (p < 0.01) between the score and the current prioritisation practice. Two-thirds of patients with a minor score (<20) were treated by bands 5 and 6. Patients with a moderate score (21–50) were rarely seen by a band 5 or 6 and were more commonly treated by a band 7 (65% of the total with a moderate score). Those with score in the severe (51–100) and major (0 >101) categories were mostly treated by a band 7 therapists (79.4% of the total with that score) compared to 17.9% by band 6 and 2.6% by band 5.

Discussion

The mHISSa as used in this study can be used as an objective tool to assist with triaging patients, in this hand therapy department. Further work is needed nationally to see if the results can be generalised to other units.