Enhanced Clinical Pathway to Directly Transfer Non-specific Back Pain Patients from Accident and Emergency Department to Rehabilitation Centre in HKW.

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Authors (including presenting author) :
Chan YM(1), Ng YL(2), Koljonen P(3), Wong YW(3), Tsang TC(4), Leung SC(4), Chu K(4), Chan CW(5), Fung YF(4), Mak A(6), Ng T(7), Tsang CCR(1), Wan K(2)
Affiliation :
(1)MMRC, Physiotherapy Department,(2)MMRC, Occupational Therapy Department,(3)QMH,Orthopaedic and Traumatology Department,(4)QMH, Accident and Emergency Department,(5)QMH, Department of Anaesthesiology,(6)MMRC, Department of Clinical Psychology,(7)MMRC, Nursing Unit.
Introduction :
Low Back Pain is common at the already overloaded Accident and Emergency Department(A&E). Many of them are non-specific low back pain not needing immediate surgical or orthopaedic intervention. Timely transfers of these patients to rehabilitation centre decongest acute hospital beds and allow early rehabilitation. This new pathway was introduced in May 2017 as part of the new Hong Kong West Cluster Back and Neck Pain Program.
Objectives :
(1)To decongest QMH through direct admission of patients from A&E to MMRC; (2)To allow immediate multidisciplinary assessment and treatment of back pain patients at a rehabilitation hospital.
Methodology :
A multidisciplinary clinical pathway was developed with the co-operation of Orthopaedic, A&E and Pain Team doctors, physiotherapists, occupational therapists, clinical psychologist, and nurses of Queen Mary Hospital(QMH) and Maclehose Medical Rehabilitation Centre(MMRC). Clinical criteria were set up to avoid missing cases requiring urgent intervention. Patients received immediate assessment and treatment by multidisciplinary once transferred to MMRC. Spine specialists closely monitor conditions and ensure early discharge.
Result & Outcome :
79 back pain patients(37 male & 42 female, mean age 53.61) were directly transferred from QMH A&E to MMRC from January to December 2018. The average length of stay at MMRC was 7.8days. The mean Numeric Pain Score reduction was 6.03/10(p< 0.001). The mean Patient Specific Function Score improvement was 5.85/10(p< 0.001). There was significant improvement of Rolland Morris Disability Questionnaire of 11.35/24points(p< 0.001). Work related outcomes were also significantly improved: Modified Barthel Index improved 6.3 points(p< 0.001), Owestry Disability Index improved 20.1%(p< 0.001), and Instrumental Activity of Daily Living improved 4.6 points(p< 0.001). Return to work rate was 73%, of which 52% retuned to work in 2 weeks. Average global improvement of 71% was achieved. 60 days readmission rate was 0%. Conclusion: This is the first attempt in HKW to directly transfer back pain patients from A&E(QMH) to MMRC. With careful screening, co-operation of doctors, nurses and allied health members of both hospitals, the goals of decongesting acute orthopaedic beds at QMH and immediate multidisciplinary rehabilitation of patients were achieved.

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