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Adherence to recommended guidelines for low back pain presentations to an Australian emergency department: Barriers
Janelle Heine1, Peter Window2, Sarah Hacker1
1Emergency 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.
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.
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