Research - SHaPED
Research Project Overview
SHaPED: Sydney Health Partners Emergency Department trial.
Patients with low back pain often seek care in emergency departments, but the problem is that many patients receive unnecessary or ineffective interventions and at the same time miss out on the basics of care, such as advice on self-management. Examples of low-value care of low back pain in emergency departments include inappropriate overuse of imaging, liberal use of opioid analgesics and unnecessary admission to hospital. This pattern of care has important consequences for the healthcare system (expensive and inefficient) and for patients (poor health outcomes). We hypothesised that the implementation of an evidence-based model of care for low back pain will improve emergency care by reducing inappropriate overuse of tests and treatments and improving patient outcomes.
The overall aim of the SHaPED trial is to implement the Agency for Clinical Innovation (ACI) model of care for acute low back pain and evaluate the use of a multi-faceted intervention on outcomes that reflect the key messages in the model:
- Patients with non-specific low back pain do not require imaging
- Where medicines are used, simple analgesics should be the first option
- Patients with non-specific low back pain should be managed as outpatients
We will measure the proportion of patients presenting with non-serious low back pain who receive imaging in the emergency department, opioids and subsequent hospital admission.
- 2018 Qlik Patient-centred App Innovation Award at the Qlik Health and Public Sector Summit
- 2018 NPS Medicinewise Award for Excellence in eHealth Resources at the 10th National Medicines Symposium
- 2018 Lyn March Award for Excellence at the Agency for Clinical Innovation (ACI) Musculoskeletal Network Forum
We use a stepped-wedge cluster randomised trial design which enables us to compare the use of the new model with the usual emergency care provided for low back pain. SNOMED codes are used to identify low back pain presentations to the emergency departments. The Sydney Local Health District (SLHD) Targeted Activity and Reporting System (STARS) is used to access and extract outcome data from participating emergency departments. STARS is data analytics programme that captures in near real-time routinely collected emergency department measures stored in electronic medical records and other hospital databases, including number of presentations, use of diagnostic imaging tests, use of medications, length of emergency stay and admissions to hospital. SHaPED also includes process and economic evaluations.
The full protocol for the SHaPED trial is published in BMJ Open and available here.
We have commenced the SHaPED trial at four emergency departments in NSW. We used a multi-faceted intervention, targeting emergency clinicians, comprising educational materials and seminars, and an audit & feedback approach. We have successfully recruited and delivered training to 274 emergency clinicians on the new model of care. We have successfully implemented our audit & feedback/data analytics tool currently including data of over 7,500 low back pain presentations. The trial follow-up period will end in February 2019 and results will be analysed and published in a peer-reviewed journal.