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

Abstract

AbstractObjectivePatients with musculoskeletal conditions (MSKCs) are highly prevalent in ED. This project explores the impact of the pilot phase of a ‘diversion pathway’, which directed patients with MSKCs from the ED waiting room to an outpatient clinic led by advanced‐scope physiotherapists.MethodsA 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.ResultsBetween May and December 2022, 1099 patients were diverted. For diverted patients, mean length of stay (LOS) in ED was reduced by 110 (95% confidence interval [CI]: 99–120) min and 4 h rule compliance improved by 19.3% compared to usual ED care. There were fewer patients who ‘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.ConclusionsA new pathway resulted in reduced LOS, reduced DNW, high patient satisfaction and more people being discharged within 4 h 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.