Application of Primary Care Guideline for Chronic Low Back Pain in the Emergency Department
Rebeca M Tacy1, Sherry Donaworth, Kathleen Ballman
1Thomas More College, Crestview Hills, Kentucky, (Dr Tacy); and University of Cincinnati College of Nursing, Cincinnati, Ohio (Drs Donaworth and Ballman).
Insights
Implementing a primary care guideline in the emergency department improved support for evidence-based practices and patient satisfaction for chronic low back pain (CLBP) management. This approach enhances patient care and resource connection for those with CLBP.
Area of Science:
- Emergency Medicine
- Primary Care
- Pain Management
Background:
- Chronic low back pain (CLBP) is a prevalent condition frequently managed in emergency departments (EDs).
- A lack of ED-specific guidelines for CLBP management presents a challenge.
- The study setting is an urban ED serving a diverse population with limited primary care access.
Purpose of the Study:
- To implement and evaluate an evidence-based primary care guideline for CLBP management in an ED setting.
- To enhance provider support for evidence-based practices and improve patient outcomes.
- To facilitate patient connection with community resources and improve pain management satisfaction.
Main Methods:
- Application of Kolcaba's Theory of Comfort and the Plan-Do-Study-Act model.
- Introduction of the Guideline for the Evidence-Informed Primary Care Management of Low Back Pain.
- Implementation of interprofessional collaboration for referrals and descriptive data analysis.
Main Results:
- Increased provider and staff support for evidence-based practice guidelines.
- Enhanced utilization of evidence-based practices in CLBP management.
- Improved patient connection to community resources, education, and overall satisfaction with pain management.
Conclusions:
- The adaptation of a primary care guideline is effective for managing CLBP in the ED.
- This model supports broader regional application of primary care guidelines in EDs.
- It paves the way for introducing other primary care guidelines for chronic conditions in emergency settings.
Abstract:
Chronic low back pain (CLBP) is a primary care condition that overflows into the emergency department (ED). No ED-specific practice guideline exists for the management of patients with CLBP in the ED setting. Back pain is a common chief complaint, with cases of CLBP making up to 50% of the patients seen with back pain in an urban, freestanding ED affiliated with a multicampus health system in the Midwest where 25% of patients live below the poverty line and 21.8% do not have primary care. Kolcaba's Theory of Comfort guides the implementation of an evidence-based practice application project. The Guideline for the Evidence-Informed Primary Care Management of Low Back Pain from the National Guideline Clearinghouse is introduced. Interprofessional collaboration for immediate referrals was implemented. The plan-do-study-act model was applied with descriptive analysis of the data. Reflective of established specific aims of the project, there was increased (1) support for the use of evidence-based practice guideline among the ED providers and staff, (2) use of evidence-based practices, (3) connection of patients to community resources, (4) evidence-based education for patients, and (5) overall satisfaction with pain management. The effectiveness of the application of this primary care guideline in the ED opens the way both for region-wide application of the guidelines and for the introduction of other primary care practice guidelines for patients who present to the ED with other chronic conditions.
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