Emergency Department Clinicians Share Perspectives on Treating Lower Back Pain

Simon Davidson

Lower back pain affects up to 4 million Australians and spans across all age and socio-economic groups. Approximately 80% of people can expect to experience lower back pain at some point in their life.

Lower back pain was the 5th most common reason for visiting the emergency department in Australia in 2017-2018 despite the recommendations of international guidelines that state it’s best to receive care in primary or community care settings.

About half of all patients with lower back pain who seek treatment in the emergency department are discharged with a non-musculoskeletal diagnosis. It’s not uncommon for lower back pain to be a symptom of an underlying problem.

Identifying the Obstacles

Investigators including Simon Davidson, School of Medicine and Public Health, The University of Newcastle, Population Health, Hunter New England Local health District, wanted to know why patients with lower back pain present to emergency departments and are then admitted to the hospital; what barriers and enablers do providers face when caring for these patients; and what are some strategies to improve the care of patients with lower back pain and associated care processes in the emergency department.

In order to optimize service delivery and improve patient care, it’s critical to explore the perspective of clinicians. Co-designing the interventions with the end-users increases the likelihood of it being accepted and implemented.

Qualitative research has been conducted covering a range of topics related to the emergency department and patients with general chronic pain. Although, no studies have specifically focused on issues that clinicians face while treating lower back pain.

Seeking Out Solutions

Emergency department clinicians were able to identify internal and external factors that they believe drive presentations of lower back pain to the emergency department. Factors included difficulty accessing appointments with general practitioners, along with a patient’s assumption that emergency departments provide the highest and fastest level of care for a patient.

Some barriers that providers face when caring for patients with lower back pain in an emergency setting extend beyond the patient presentation and decisions about what treatments to provide. Service level demands, like a patient’s length of stay, are important concerns that need to be addressed in order to optimize care.

Emergency department clinicians identified key strategies that could improve the care of patients with lower back pain. These strategies include a department-specific lower back pain pathway, modernized patient and clinician resources, better follow-up options post-discharge, and optimizing communication between the emergency department and primary care.

The Structure of the Study

Investigators conducted a qualitative exploratory study with emergency department clinicians (medical officers, nurses, and physiotherapists) at a tertiary-level public hospital in New South Wales, Australia. They used focus groups and individual interviews.

Participants included 21 clinicians with 2 individual interviews and 19 in focus groups. Investigators used thematic analysis on the participants’ responses to answer the predefined research questions.

Ultimately, they found that patient perception was suspected to be the driving motivator to these patients seeking treatment from the emergency department. Also, achieving optimal care included patient-, clinician-, and service-level factors.

“Each professional group focussed their discussion on areas that are most relevant to them,” investigators wrote, “medical officers, clinical decisions and follow-up options; nurses, the provision of care to patients; and physiotherapists, optimizing function.”

The study, “Perspectives of emergency department clinicians on the challenges of addressing low back pain in the emergency setting: A qualitative study," was published in Emergency Medicine Australasia.