A novel pathway for patients with low back pain referred to emergency department

To describe a novel, innovative patient pathway for patients with LBP referred to ED. To describe a novel, innovative patient pathway for patients with LBP referred to ED. 

We used the template for intervention description and replication (TIDieR) checklist and guide to describe the novel patient pathway for patients (age ≥18 years ) referred to the Trauma Centre and Emergency Department (ED), Viborg Regional Hospital, Denmark with a LBP-related diagnosis.

In the novel patient pathway, the general practitioner referring the patient with LBP calls the ED-visitation as usual but is now directly connected to a spine supervisor (a rheumatologist). This function is adapted from an existing patient pathway in patients with chronic LBP. The general practitioner and the spine supervisor agree whether the patient is: 1) finalised by the general practitioner with adequate instructions, including the possibility of referral to physiotherapy, 2) assigned a sub-acute (next day) multidisciplinary assessment by a rheumatologist and a physiotherapist at the Medical Spine Center, Silkeborg Regional Hospital, or 3) admitted to the ED, Viborg Regional Hospital, for a clarification of serious disease.

We propose a novel patient pathway combining a telephone consultation directly between the referring general practitioner and a spine supervisor and a possibility of a sub-acute multidisciplinary assessment at a Medical Spine Clinic. The patient pathway has been described in detail according to TIDieR and will be feasibility tested in spring 2025.

The novel patient pathway supports management of LPB according to guidelines, and potentially reduces unnecessary ED admissions. Those who require immediate intervention can be prioritized, while others may be managed in primary care or referred for further subacute multidisciplinary assessment. Physiotherapists play a vital role in the management in primary care and in the subacute multidisciplinary assessment, bringing expertise in musculoskeletal pain and a biopsychosocial approach that helps support self-management strategies and education for patients with LBP.