What an MSK triage tool should do.
What an MSK triage tool is
An MSK triage tool is software that helps sort patients with musculoskeletal problems, meaning joints, muscles, bones and soft tissues. It helps decide three things: how urgent the problem is, who the patient should see, and what should happen before that appointment so it is not wasted.
The term covers very different products. Before comparing any of them, it is worth asking which of three kinds you are looking at, because they solve different problems and carry different risks.
Three kinds of MSK tool
Used by the patient
Online self-referral and self-triage. The patient answers questions on a phone or website and is routed to advice, exercises, physiotherapy or a clinician. Built for volume and access.
Used by the clinician
Decision support in the consultation. A physiotherapist, first contact practitioner or GP assesses the patient and the tool helps with the diagnosis, the test and the next step. The clinician decides.
Used by the hospital
Referral management. Letters arriving at a hospital are sorted into urgent and routine, right clinic and wrong clinic, often without the patient being seen.
Six questions to ask of any MSK tool
Whether you run an NHS service, a private clinic or a health insurance scheme, the same six questions separate a tool you can defend from one you cannot.
Who uses it? A tool used by patients and a tool used by clinicians need different safeguards and answer to different standards.
Does it show its reasons? If a suggestion cannot be explained, it cannot be checked, taught or defended.
Who wrote the rules, and can they be read? Every suggestion should trace back to named clinical authority and to published evidence.
Does it ask about urgent problems first? Infection, fracture, suspected cancer and other problems that cannot wait should be ruled out before anything else.
Does it count errors in both directions? A tool judged only on how many referrals it prevents will miss the patients who needed a surgeon sooner.
Which standards does it meet? In the NHS that means clinical risk management to DCB0129 and DCB0160, the Digital Technology Assessment Criteria (DTAC), and medical device regulation where the software influences clinical decisions.
Surgical decision support inside MSK triage
Most tools built for MSK triage aim to keep people out of hospital. Orwyn helps the clinician decide when a patient should go in, when they should not, and gives the clinician and the patient a reason to trust the answer.
Orwyn is clinician-facing. It puts a consultant knee surgeon's written judgement into the first contact consultation: the safety questions first, the most likely diagnosis with its reasons, the test to request, what to do today, and whether and how urgently a surgeon is needed. The clinician can agree or disagree, and a disagreement is recorded, never overridden.
Orwyn is currently being assessed for an NHS pilot to test its safety, clinical effectiveness and cost effectiveness.
We explain the category in what MSK clinical decision support is, and how the tool works in what Orwyn does. For how triage is organised and measured in the NHS, read how NHS MSK triage works.
Where to read more
Musculoskeletal orthopaedic approach to referral optimisation, NHS England.
Digital Technology Assessment Criteria (DTAC), NHS England. Read it here.
MHRA guidance on software and AI as a medical device, MHRA.
MSK triage explained, our companion reference page. Read it here.
Surgeon-governed decision support for first-contact MSK clinicians.