Referral criteria from primary care - knee osteoarthritis

The majority of the management of patients with osteoarthritis of the knee is undertaken in primary care . Patients should, however, be referred to a specialist service if:

****there is evidence of infection in the joint

*** there is evidence of acute inflammation

** giving way is a problem despite therapy

** symptoms rapidly deteriorate and are causing severe disability

* the symptoms impair quality of life. The timing of the appointment should depend on the extent to which the condition is causing pain, disability, sleeplessness, loss of independence, inability to undertake normal activities, reduced functional capacity or psychological upset. An explicit scoring system for these should be developed locally in a partnership involving primary and secondary care

+ drug treatment causes a severe unwanted effect

+ the diagnosis is, or becomes, uncertain

Key to referral times:

**** immediate referral (a)

*** urgent referral (b)

** soon (b)

* routine (b)

+ times will be discretionary and depend on clinical circumstances

(a) within a day

(b) Health authorities, trusts and primary care groups should work to local definitions of maximum waiting times in each of these categories. The multidisciplinary groups considered that a maximum waiting time of 2 weeks is appropriate for the urgent category

Reference:

1. NICE (May 2000). Referral Practice A guide to appropriate referral from general to specialist services.