Short waits, happy patients and expert care, moving basic musculoskeletal care from the ED to a physiotherapist led diversion pathway

Abstract

Objective: Patients with musculoskeletal conditions are highly prevalent in emergency departments (ED). This project explores the impact of the pilot phase of a ‘diversion pathway’, which directed patients with musculoskeletal conditions from the ED waiting room to an outpatient clinic led by Advanced Scope Physiotherapists.

Methods: A prospective intervention study comparing care outcomes between patients in the ‘diversion pathway’ with usual ED care. The characteristics of patients considered eligible and non-eligible are described. Results: Between May and December 2022, 1,099 patients were diverted. For diverted patients, mean length of stay (LOS) in ED was reduced by 110 (95%, CI 99–120) minutes and 4-hour rule compliance improved 19.3% compared to usual ED care. There were fewer patients that ‘did not wait’ (DNW) with the diversion pathway. The diverted group was young (median age 22 years and 41% paediatric), mostly low urgency, self-referred and arrived by private transport with minor limb trauma. The diversion pathway triage process appropriately identified 182 patients ineligible for diversion. 96.7% of patients reported satisfaction with care received from the diversion pathway. There was no change in ED representation rates for diverted patients. Conclusions: A new pathway resulted in reduced LOS, reduced DNW, high patient satisfaction and more people being discharged within 4 hours for diverted patients compared to usual ED care. The pathway increased ED capacity, improved key ED performance metrics and safely expedited care delivery for patients.