Is Emergency Department Care for Low Back Pain Meeting Contemporary Standards? A Medical Record Review

TL;DR

This study evaluates how well a hospital's emergency department follows new guidelines for treating low back pain and finds mixed results.

Contribution

The study assesses adherence to new Australian clinical standards for low back pain care in an emergency department setting.

Findings

Clinical assessment and screening for serious conditions were documented in 74% of cases.

Only 17% of patients received self-management advice or psychosocial risk screening.

Opioids were administered in 62% of cases, indicating potential overuse.

Abstract

In 2022, the Australian Commission on Safety and Quality in Healthcare released clinical care standards for managing low back pain (LBP), including in emergency departments (EDs), where guideline non‐adherent care has been reported. This study aimed to describe LBP care in a tertiary hospital ED against these new clinical standards.

A 12‐month retrospective review of medical records from a random sample of adults with LBP presenting to a tertiary hospital ED. Outcomes focused on key aspects of LBP care aligned with the eight quality statements in the Low Back Pain Clinical Care Standards (LBPCCS). Descriptive statistics were used to describe care against the quality indicators.

Of the 1974 ED presentations with a LBP‐related discharge diagnosis in 2023, 550 were randomly selected for review. After exclusions, 374 were assessed against the LBPCCS. All presentations were assessed against the clinical assessment outcomes (quality statements 1–3), and 335 presentations were assessed against the ED management outcomes (quality statements 4–8). Clinical assessment and screening for serious/specific pathology was documented in 278 cases (74%); appropriate imaging in 66 (56%); self‐management advice in 56 (17%); and psychosocial risk screening with referral in 56 cases (17%). Opioids were administered in 208 cases (62%) and anti‐convulsants in 52 (16%).

In a tertiary hospital ED, adherence to the LBPCCS is varied. The ED performed well against the clinical assessment/screening outcomes. However, findings suggest strategies are needed to improve performance against the management outcomes, including management advice, identification of psychosocial risk factors, and opioid use.