#78 Improving the quality of care for patients with musculoskeletal low back pain attending the emergency department at university hospital Galway

<h3>Introduction</h3> Low back pain is a prevalent issue in emergency departments (EDs) worldwide, with over 4 million annual presentations in the USA. Guidelines discourage routine imaging, opioid use, and hospital admissions for low back pain. However, studies show 66% of ED patients with acute low back pain are prescribed opioids, 33% undergo imaging, and another 33% are admitted. Such practices can be resource-intensive, prompting the Lancet Low Back Pain series to advocate for urgent management changes. Stratified physiotherapy care has proven effective in improving patient outcomes and reducing socioeconomic burdens. At GUH, the ED manages a significant number of musculoskeletal low back pain cases annually. A review of January-March 2023 presentations revealed that 58% of patients received X-rays, 38% were prescribed medications outside NICE guidelines, only 14% of suitable patients were referred to physiotherapy, and 20% re-presented within 7 days. <h3>Methods</h3> We reviewed 100 patient cases from January to March 2023 to assess current practices. A stakeholder group was established, and a Smart Aim statement was formulated. Quality improvement tools, including a fishbone diagram, communication plan, stakeholder map, and driver diagrams, were utilised. Interventions such as education sessions, posters, and daily reminders were implemented starting in November 2023. Progress was tracked weekly using run charts. <h3>Results</h3> As of July 2024, significant progress has been achieved: X-ray rates decreased from 58% to 11%, physiotherapy referrals increased from 14% to 70%, re-presentation rates dropped from 20% to 4.5%, and medication prescriptions outside NICE guidelines reduced from 38% to 21%. These changes have resulted in annual cost savings of €43,750-€65,000 from reduced re-presentations and €11,830 from decreased X-ray imaging. <h3>Conclusion</h3> Quality improvement interventions in the ED can significantly enhance patient care, reduce re-presentation rates, increase efficiency, and lower costs.