Managing non-traumatic musculoskeletal conditions presenting to emergency departments: Do patient profiles vary between a physiotherapy-led 'Diversion' pathway and routine care?

Abstract

Background: Low urgency, non-traumatic musculoskeletal presentations are common in emergency departments. Although care is safe, it is expensive, and low priority. Pathways diverting these patients from emergency departments to physiotherapy care may improve hospital outcomes. Identifying the suitable patient profile for these pathways is important.

Methods: A mixed prospective and retrospective, descriptive, cross-sectional study investigated adults aged 18-65 presenting to two emergency departments. Suitable patients were diverted directly to a physiotherapy outpatient diversion pathway. Three groups were compared, diverted patients, patients suitable but not diverted, and patients unsuitable for diversion.

Results: Diverted patients were aged 43 (median, inter-quartile range 34-53.5) years, triaged as low-urgency, self-referred, self-transported, and had few concerning features of serious pathology. Diverted patients had a 113-minute shorter emergency stay at 79 (median) minutes compared to suitable but not diverted patients, and both groups had a similar profile. Most (93.4 %) diverted patients were discharged within 4- hours, compared to suitable but not diverted patients (72.9 %). Key factors preventing diversion were concern for serious pathology or diversion capacity restraints.

Conclusion: A group of patients with non-traumatic musculoskeletal conditions who can be safely diverted to physiotherapy outpatients are described. Diversion impact was high quality care and improved emergency department metrics.