Up to six in 10 back pain inpatient admissions are non-serious and could be managed in a ‘virtual hospital’, Australian clinicians say.
A study of 1,982 emergency department (ED) admissions with provisional non-serious back pain diagnoses found 57% could have been managed with a ‘virtual hospital’ model of care consisting of home visits and remote monitoring.
Nearly 40% of patients with the same provisional diagnosis were appropriately in hospital, with 14% of all patients harbouring a “serious spinal pathology” such as fracture or infection and 24%, a “serious pathology beyond the lumbar spine”, including pathological fracture or neoplasm.
Diverting patients with definite non-serious back pain to ‘virtual hospitals’ could relieve the three assessed Sydney-based EDs of around 250 patients per year and avoid admission costs of $15,000 per person, according to physiotherapist and University of Sydney Institute for Musculoskeletal Health researcher Alla Melman and her team, writing in Clinical Rheumatology.
However, patients’ safety, quality of care and the model’s success will depend on careful selection to the program, they cautioned.
“A key clinical challenge in implementing virtual hospital care is the differential diagnosis of non-serious, serious spinal, and non-lumbar pathologies in those presenting to ED with back pain,” they wrote.
“Protocols need to be developed to reduce the risk of patients being admitted to virtual hospitals with serious pathology as the cause of their back pain.”
This may include “transfer to virtual care from ED short-stay units or the inpatient ward, once laboratory tests and imaging results are available to confirm non-serious back pain”, Mrs Melman and colleagues advised.
They would also need to consider patients’ comorbidities, existing social support, ability to navigate virtual care, and preferences — factors which were not considered in this study.
Clinicians should watch out for provisionally non-serious back pain patients aged 65 years and older, who were more likely to have serious spinal and non-lumbar pathologies than their younger counterparts, with prevalence rates of 16% versus 11% and 27% versus 19%, the study suggested.
A virtual hospital model for back pain management is set to be evaluated in the Sydney Local Health District this year, with Mrs Melman, founding Director of the Institute for Musculoskeletal Health and the team including Professor Chris Maher and colleagues investigating implementation and efficacy of possible clinical pathways.