Adherence to recommended guidelines for low back pain presentations to an Australian emergency department: Barriers and enablers

Janelle Heine; Peter Window; Sarah Hacker; Jordan Young; Gary Mitchell; Shea Roffey; Michelle Cottrell

doi:10.1016/j.auec.2023.04.003

Adherence to recommended guidelines for low back pain presentations to an Australian emergency department: Barriers and enablers

Australas Emerg Care. 2023 Dec;26(4):326-332. doi: 10.1016/j.auec.2023.04.003. Epub 2023 May 14.

Authors

Janelle Heine¹, Peter Window², Sarah Hacker³, Jordan Young⁴, Gary Mitchell⁵, Shea Roffey⁶, Michelle Cottrell²

Affiliations

¹ Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4006, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4006, Australia. Electronic address: janelle.heine@health.qld.gov.au.
² Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4006, Australia.
³ Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4006, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4006, Australia.
⁴ Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4006, Australia; University of Queensland, St Lucia, Queensland 4067, Australia.
⁵ Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4006, Australia; Jamieson Trauma Institute, Herston, Queensland 4006, Australia; University of Queensland, St Lucia, Queensland 4067, Australia.
⁶ Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4006, Australia.

PMID: 37193622
DOI: 10.1016/j.auec.2023.04.003

Abstract

Objective: This study sought to evaluate the adherence to guidelines for the management of mechanical Low Back Pain within a single tertiary metropolitan Emergency Department setting. Our objectives were: METHODS: A two-stage multi-methods study design was undertaken. Stage 1 involved a retrospective chart audit of patients presenting with a diagnosis of mechanical Low Back Pain to establish documented adherence to clinical guidelines. Stage 2 explored clinicians' perspectives towards factors influencing adherence to the guidelines via a study-specific survey and follow up focus groups.

Results: The audit demonstrated low adherence to the following guidelines: (i) appropriate prescription of analgesia, (ii) targeted education and advice, and (iii) attempts to mobilise. Three major themes were identified as factors influencing adherence to the guidelines: (1) clinician driven influences and factors, (2) workflow processes, and (3) patient expectations and behaviours.

Conclusion: There was low adherence to some published guidelines and factors influencing adherence to the guidelines were multi-factorial. Understanding the factors that influence care decisions and developing strategies to address these can improve Emergency Department management of mechanical Low Back Pain.

Keywords: Education; Emergency department; Low back pain; Opioids; Practice guideline.

MeSH terms

Australia
Emergency Service, Hospital
Guideline Adherence
Humans
Low Back Pain* / therapy
Retrospective Studies