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

Area of Science:

• Emergency Medicine
• Physiotherapy
• Clinical Guideline Implementation

Background:

• Low back pain (LBP) is a common reason for emergency department (ED) visits.
• Current management in EDs often involves suboptimal guideline adherence and high healthcare utilisation.
• The PLEDGE model was developed to improve care for LBP presentations.

Purpose of the Study:

• To evaluate the impact of the PLEDGE model on guideline adherence and healthcare utilisation for LBP in the ED.
• Assessing changes in opioid analgesia use, imaging, and pathology ordering.
• Examining effects on ED access targets, re-presentations, short stay unit admissions, and length of stay.

Main Methods:

• A pre- and post-implementation study design was used.
• Data from 2732 LBP ED presentations were extracted from electronic medical records.
• Primary outcomes included opioid analgesia use and ED National Emergency Access Target (NEAT); secondary outcomes included imaging, pathology, re-presentations, SSU admissions, and ED length of stay (LOS).

Main Results:

• Opioid analgesia use and pathology ordering significantly decreased post-PLEDGE implementation (p < 0.001 and p = 0.012, respectively).
• There was no significant reduction in imaging requests (p = 0.173).
• ED NEAT worsened, ED LOS increased, but patients were less likely to be admitted to SSU (p = 0.012) or re-present to ED (p = 0.043).

Conclusions:

• The PLEDGE model successfully reduced opioid analgesia use and pathology ordering, indicating improved guideline adherence.
• The model acted as a safety net, reducing SSU admissions and ED re-presentations.
• Despite improvements in specific adherence metrics, ED operational efficiency (NEAT, LOS) requires further attention.