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Too many people with back pain are calling for ambulances or visits ED. This is why this is a problem
May
Around 4 million Australians experience problems back and people are more and more often I call ambulances and presenting emergency departments to deal with back pain.
However, most of these cases of back pain do not require emergency care. Back pain is a symptom, not a disease. When the symptoms last longer than 12 weeks, they are referred to as chronic back pain. The most common form of back pain is Non -compassive back pain – This term is administered when the tissue or structure cannot be identified as the cause.
Non -specific back pain was usually the best managed primary careBy GPS and Allied healthcare workers.
Once, people with non -serious back pain will contact emergency health services, they are more likely that he will receive care This is not recommended and is considered low and sometimes harmful.
This may include unnecessary laboratory tests, such as blood tests and imaging, such as X -rays, CT or MRI scans. One -third of imaging demands In the case of back pain in emergency departments, they are not clinically justified and are assessed as inappropriate.
However, in some cases it is recommended that people with back pain to contact an ambulance or present in the emergency department. This includes when back pain is the result of trauma, when people live alone without access to carers, when people have other elaborate presentations and when people show signs of potentially grave conditions.
Unnecessary admission to the hospital are exorbitant to the healthcare system and can cause damage to patients. Almost one in four (24%) people admitted to the hospital for back pain acquire infections or experience.
Drugs prescribed in the hospital can also have negative consequences for the patient. Almost one in ten Patients with back pain still take opioids after a discharge, risk of dependence and overdose. One in three patients Continue using opioids a month after visiting the emergency department.
Read more: Opioids do not relieve acute lower or neck pain – and can cause worse pain, modern studies find
The influx of back pain presentation to emergency health services also has the consequences of overcrowding of the emergency department and ambulance. This means that other ambulance patients cannot enter the emergency department and cause longer waiting times.
Why is this happening?
In primary health care, the treatment of back pain is well determined in Clinical practices guidelines. But Emergency health services They do not have guidelines specific to back pain. This is probably due to the lack of evidence of these settings (though evidence base has increased in the last five years).
Lack of specific tips means that there is a high probability that people lose proper care and receive improper care.
A key challenge for emergency clinicians is to distinguish patients with back pain who require emergency care from those who do not do it.
One Australian study It was found that 38% of patients in the emergency department, which initially diagnosed, not grave back pain later, had a specific pathology, such as infection, during admission to the hospital. In such cases, it is necessary to further diagnostic investigation and emergency care.
But almost half of the ambulance and ambulance patients without a grave pathology receive unnecessary care. Our last study It was found that 81% of people who provided an ambulance service with back pain were transferred to the emergency department.
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In the emergency department, 46% of ambulance patients received opioids, 59% received imaging and 50% were accepted. However, it is not clear what percentage actually required care at the emergency department.
Clinics are obliged to make quick decisions regarding patient care. For medical rescuers, Limited range Drugs and access to social health services, especially outside of working hours, ultimately leaves them no other option than transporting the patient to the hospital.
Clinics of the emergency department must manage people complex presentations and many conditions and deal with the expectations of patients regarding opioids and imaging. This may affect their care decisions.
How can an emergency protection protection be improved?
The key area of improvement is to reduce the operate of opioids. Some New southern Wales Trial Reduced operate of opioids in case of back pain in emergency departments by introducing a modern care model. The model included the education of clinicists, implementation of provisions other than opioid, such as heat packages and timely referrals to outpatient services, such as specialized Back clinics.
This approach will be now scaled Turn on 44 emergency departments throughout the NSW. If you succeed, it can be introduced throughout the country.
Virtual hospitals They have also been implemented to reduce personal presentations to emergency departments in the field of back pain, which often means that people with back pain can be care, remaining at home. However, the effectiveness and safety of this modern service have not yet been established, although the research is underway.
The Australian government promised to open more urgent care clinics, in which a doctor, nurse or a physiotherapist may be a physician with urgent but not life -threatening complaints. The service allows people with back pain for personal care, while turning them away from the emergency department. But although they seem a good idea, we have no evidence of their value.
To reduce the load that back pain applies to emergency health services, changes should be made at all levels of the healthcare system. But these changes must be supported by reliable research evidence.
Better information for patients and clinicians
The audience must be aware of when and where to look for proper care for back pain. This can be achieved through successful Health promotion initiatives.
In the case of clinicists, special back pain and hospital emergency service should be developed and implemented. Decision -makers, health services managers and stakeholders must revise its current policy to adapt to the latest evidence.
In addition, it is necessary to develop straightforward -to -access paths between health in emergency health and the community of the community health to maintain people with non -serious back pain in the hospital to reduce the risk of obtaining unnecessary and exorbitant care.
