Variable Adherence to Australian Clinical Care Standard: An Audit of Patients With Acute Low Back Pain Attending a Tertiary Emergency Department.

BACKGROUND

Low back pain (LBP) has the second highest burden of disease in Australia and is the 5th most common reason for attending an Emergency Department (ED). Variation in clinical care is linked to poorer outcomes and higher health care costs. In 2022, the Australian Commission for Safety and Quality in Healthcare (ACSQHC) released the LBP Clinical Care Standard (LBP CCS). An audit was completed at a tertiary metropolitan hospital ED to benchmark the care of patients attending with LBP against the LBP CCS.

METHODS

The medical notes of all adult patients with a diagnosis of LBP, attending Royal Perth Hospital (RPH) ED between 1 January and 31 March 2023 were reviewed. A total of 170 records met the inclusion criteria and were audited against the LBP CCS. A groupwise threshold of 80% was set a priori to confirm acceptable adherence of recorded practice with each item of the LBP CCS.

RESULTS

Screening for serious spinal pathologies and appropriate patient review demonstrated the highest adherence, with imaging rates close to meeting the pre-determined threshold. No patients were screened for psychosocial factors and compliance with the remaining LBP CCS items was low.

CONCLUSION

This audit demonstrated that care for people with LBP in a tertiary ED did not meet the recommendations set out by the LBP CCS. A multifaceted approach incorporating a pathway within ED, with ongoing clinician education to implement contemporary LBP management, is warranted to reduce this variation and facilitate higher value care for patients with LBP.