A Physiotherapy-Led Emergency Department Guideline (PLEDGE) for Patients Presenting With Low Back Pain: Pre- and Post-Implementation Study

IF 1.7 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia Pub Date : 2025-05-19 DOI:10.1111/1742-6723.70057

Rosalie Gan, Caitlin Farmer, Alisha da Silva, Katharine Drummond, Lucinda Marr, John H. Y. Moi, Mark Putland

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引用次数: 0

Abstract

Objective

We evaluated guideline adherence and healthcare utilisation in an emergency department (ED) pre- and post-implementation of a physiotherapy-led low back pain (LBP) guideline and rapid outpatient follow-up service (collectively termed PLEDGE model).

Methods

The PLEDGE model was implemented in a metropolitan tertiary hospital. Data from LBP ED presentations were extracted from electronic medical records for 1 year pre- and post-PLEDGE model implementation. To evaluate guideline-adherent care, the primary outcome was the incidence of any opioid analgesia use. Requests for imaging and pathology were secondary outcomes. To evaluate healthcare utilisation, the primary outcome was the ED National Emergency Access Target (NEAT). Secondary outcomes included ED re-presentations within 28 days, short stay unit (SSU) admissions and ED length of stay (LOS).

Results

Overall, 2732 patients were included (1384 post-implementation). For guideline-adherent care, opioid analgesia (χ² (1, N = 2732) = 17.406, p < 0.001) and pathology ordering (χ² (1, N = 2732) = 6.363, p = 0.012) significantly reduced post-implementation; however, there was no reduction in imaging requests (χ² (1, N = 2732) = 1.859, p = 0.173). With respect to healthcare utilisation, measures of ED NEAT and ED LOS worsened. Patients were significantly less likely to be admitted to SSU (χ² (1, N = 2732) = 6.356, p = 0.012) or re-present to ED (χ² (1, N = 2732) = 4.098, p = 0.043).

Conclusion

Implementation of the PLEDGE model reduced opioid analgesia use, pathology ordering, SSU admissions and ED re-presentations and provided a valuable safety net. ED NEAT worsened, ED LOS increased and imaging requests remained unchanged.

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以物理治疗为主导的急诊科指南（PLEDGE）用于腰痛患者：实施前和实施后研究

目的：我们评估急诊科（ED）实施以物理治疗为主导的下腰痛（LBP）指南和快速门诊随访服务（统称为PLEDGE模型）前后的指南依从性和医疗保健利用情况。方法在某城市三级医院实施PLEDGE模式。从pledge模型实施前后1年的电子病历中提取LBP ED报告的数据。为了评估指南依从性护理，主要结局是任何阿片类镇痛药使用的发生率。影像学和病理检查是次要结果。为了评估医疗保健利用，主要结果是ED国家紧急准入目标（NEAT）。次要结局包括ED在28天内再次出现、短期住院单位（SSU）入院和ED住院时间（LOS）。结果共纳入2732例患者（实施后1384例）。对于遵循指南的护理，阿片类镇痛（χ2 (1, N = 2732) = 17.406, p < 0.001）和病理排序（χ2 (1, N = 2732) = 6.363, p = 0.012）显著减少；然而，影像学要求没有减少（χ2 (1, N = 2732) = 1.859, p = 0.173）。在医疗保健利用方面，ED NEAT和ED LOS指标恶化。患者入住SSU （χ2 (1, N = 2732) = 6.356, p = 0.012）或再次入住ED （χ2 (1, N = 2732) = 4.098, p = 0.043）的可能性显著降低。结论PLEDGE模型的实施减少了阿片类镇痛药的使用、病理排序、SSU入院和ED的再次出现，并提供了一个有价值的安全网。ED NEAT恶化，ED LOS增加，影像学要求保持不变。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Emergency Medicine Australasia 医学-急救医学

CiteScore

3.70

自引率

13.00%

发文量

217

审稿时长

6-12 weeks

期刊介绍： Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine. Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.