Adherence to recommended guidelines for low back pain presentations to an Australian emergency department: Barriers and enablers

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:

• 1.

  To identify the proportion of patients presenting to a single Emergency Department with mechanical Low Back Pain who received management in line with the guidelines; and

• 2.

  To understand and describe factors that can influence clinicians’ (non-) adherence to the guidelines.

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.