Managing back pain in an ED

 

Over the past two years, Royal North Shore Hospital (RNSH) emergency department has introduced an advanced practice physiotherapy service, utilising an evidence-based pathway to improve the clinical management of acute back pain.

A senior physiotherapist aims to assess patients with acute non-specific back pain, or back pain with leg pain, who present to the emergency department between 8.00 am and 6.00 pm. An individualised management plan is developed with the patient utilising the model of care for the Management of People with Acute Low Back Pain, a publication released by the Agency for Clinical Innovation (ACI). A consumer booklet based on this model of care has been extremely successful in enabling patients to understand the management of their condition depending on their specific presentation.

These booklets can be ordered without cost from the NSW ACI. Click here to access them.

The advanced practice physiotherapy service model has had significant impacts on patient care for those presenting with back pain. From February 2016 to September 2017, 383 back pain patients were assessed by a physiotherapist in the RNSH emergency department, and 84 per cent (322) of these patients were discharged home. Evaluation of this model of care demonstrates an 11 per cent reduction in admissions from emergency after the introduction of the physiotherapy back pain service. The average cost of a hospital admission for back pain is $3450. Utilising a physiotherapy service at the front door demonstrates a saving of approximately $331,200 annually.

In addition to face-to-face management, a physiotherapy-led telephone initiative has been developed to ensure patients with acute back pain without serious pathology are offered follow-up care after discharge. These strategies have demonstrated a decrease in the representation rate to RNSH emergency department.

A dedicated physiotherapy service in an emergency department should be considered for patients with acute back pain because the service has demonstrated the ability to improve quality of care and reduce cost to the health system.

 

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