Dr Niamh L Mundell1, Prof Paul Buntine2,3, Mr Joseph Miller2,3, Mr Liam Hackett2,3, Ms Claire L Samanna3, Ms Diya Patel3, Dr Ulrike H Mitchell4, A/Prof Patrick J Owen2,3
1Deakin University Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia, 2Eastern Health Emergency Medicine Program, Melbourne, Australia, 3Eastern Health Clinical School, Monash University, Melbourne, Australia, 4Department of Exercise Sciences, Brigham Young University, Provo, United States of America
Biography:
Dr Niamh L Mundell is an Accredited Exercise Physiologist and emerging leader in exercise physiology research, ranking within the top-1% for exercise expertise worldwide (Expertscape). Niamh has substantial clinical and industry expertise, acknowledged by her Exercise and Sports Science Australia (ESSA) Fellowship status awarded for significant contributions and a high level of professional accomplishment; Deakin University Dean's Post-Doctoral Research Fellowship; Senior Lecturer role in the Deakin Master of Clinical Exercise; and elected Non-Executive Director role for ESSA. Her research focusses on improving healthcare via inclusion of exercise physiology within usual care for people living with chronic/complex health conditions.
Abstract:
Background:
Emergency departments experience systematic overcrowding, which may be partially mitigated by better integrating referral to allied health providers in primary care. Current referral practices from the public hospital emergency department to community-based allied health are unknown. We examined current public hospital emergency department referral practices to allied health and associated factors among patients with musculoskeletal conditions.
Methods:
A retrospective audit including 276 patient charts (mean [SD] age: 45.5 [19.8] years) was conducted. Primary outcomes were internal and external referrals to allied health. Secondary outcomes were patient assessment/treatment factors.
Results:
A majority of patients received an external referral (n=163, 59%), yet only 17% (n=48) were to allied health, all of which were for physiotherapy. Allied health represented 3.6% (n=10) of internal referrals (n=27, 9.8%). Higher odds of internal referral to physiotherapy were associated with low back disorders (OR [95%CI]: 8.36 [2.27, 30.76], P=0.001), and taking prescribed pain (5.94 [1.73, 20.31], P=0.005) or cardiovascular medication (5.94 [1.73, 20.31], P=0.005). Higher odds of external referral to physiotherapy were associated with low back disorders (OR [95%CI]: 2.90 [1.50, 5.62], P=0.002), taking prescribed depression medication (3.28 [1.07, 10.06], P=0.038), and use of musculoskeletal/mobility assessment (5.21 [1.69, 16.03], P=0.004).
Conclusion:
A minority of patients with musculoskeletal conditions received external referral to allied health and all were to physiotherapy. Investigation of patient and clinician perspectives on barriers and enablers of direct referral to primary care from the emergency department is warranted for patients with non-urgent musculoskeletal complaints. Broader multidisciplinary input into care planning could be incorporated.