Strategies to improve flow and lower hospital admissions for low back pain in the Emergency Department: an interrupted time-series study

BackgroundLow back pain (LBP) is a common, disabling condition that often results in presentation to the emergency department (ED). We assessed the impact of a suite of co-designed improvement strategies to support ED clinicians to improve the flow and reduce admission rate of people with LBP presenting to the ED. MethodsAn interrupted time series study in a 30-bed ED at an Australian tertiary referral hospital. We implemented four improvement strategies: i) development of a local ED guideline, ii) patient handout, iii) clinician education program, and iv) rapid-access physiotherapy follow-up clinic. We included all ED presentations from patients 16 years and over, with a diagnosis of LBP. We compared a pre-implementation phase (July 2014–December 2019), a transition phase (July 2020–February 2021), and a post-implementation phase (March 2021–November 2021). Our primary outcome was the proportion of patients admitted to hospital, assessed by comparing the difference in the trend of monthly admission rates between phases, particularly pre-post. Secondary outcomes included ED length of stay, ED presentation cost, re-presentations within five days, and admission length of stay.ResultsThere were 5,301 LBP presentations pre-implementation, 752 transition and 732 post-implementation. The mean age of patients was 50.3 (20.1) years, 53% were female, and 6.5% identified as Aboriginal and/or Torres Strait Islander. We observed a small reduction (2%) in the change in proportion of admissions per month and a monthly decrease of 1.5 minutes in the average ED length of stay from post-implementation to pre-implementation; however, based on the confidence intervals, we cannot exclude an increase in both variables.ConclusionOverall, the results indicate the improvement strategies did not impact patient flow through the ED. The strategies implemented in this study may have contributed to small positive effects on the admission rate and ED length of stay. However, based on the measured confidence intervals, the certainty of findings is low.