Virtual hospitals: why we need them, how they work and what might come next

Melman, Alla; Maher, Chris G; Machado, Gustavo C

doi:10.1016/j.jphys.2021.06.018

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…These approaches are emerging as evidence-based practices in emergency departments [ 71 , 81 , 82 ] but the effect on hospitalisations continues to be challenging. Policy makers and hospital administrators should consider innovative, alternative pathways to emergency departments for people with LBP, such as virtual hospital care [ 83 ], especially for people arriving to emergency departments via ambulance. Hospital avoidance strategies will have the greatest impact by improving access to community-based care strengthened by partnerships with hospital health services [ 72 , 74 , 84 , 85 ].…”

Section: Discussionmentioning

confidence: 99%

Systematic review of predictors of hospitalisation for non-specific low back pain with or without referred leg pain

Orlando,

Beard,

Guerin

et al. 2023

PLoS ONE

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Significant costs and utilisation of healthcare resources are associated with hospitalisations for non-specific low back pain despite clinical guidelines recommending community-based care. The aim of this systematic review was to investigate the predictors of hospitalisation for low back pain. A protocol was registered with PROSPERO international prospective register of systematic reviews (#CRD42021281827) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Database search of Ovid Medline, Emcare, Embase, PsycINFO, Cochrane Library, PEDro and OTSeeker was conducted. Studies were included if they examined a predictor of hospitalisation for non-specific low back pain with or without referred leg pain. Data was extracted and descriptively synthesised. Risk of bias of included studies was assessed using the Critical Appraisal Skills Programme Checklists. There were 23 studies published over 29 articles which identified 52 predictor variables of hospitalisation for low back pain. The risk of hospitalisation was grouped into themes: personal, health and lifestyle, psychology, socioeconomic, occupational, clinical, and health systems and processes. There was moderate level evidence that arrival to an emergency department via ambulance with low back pain, and older age increase the risk of hospitalisations for low back pain. There was low level evidence that high pain intensity, past history of low back pain, opioid use, and occupation type increase the risk of hospitalisation for low back pain. Further research into psychological and social factors is warranted given the paucity of available studies. Hospital avoidance strategies, improved patient screening and resource utilisation in emergency departments are considerations for practice.

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Section: Discussionmentioning

confidence: 99%

Systematic review of predictors of hospitalisation for non-specific low back pain with or without referred leg pain

Orlando,

Beard,

Guerin

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

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“…Patient‐centered clinical pathways, which result in an efficient and accurate diagnosis, reduction in pain, improvement in function, avoidance of unnecessary admissions, expedited multi‐disciplinary discharge planning, and minimization of hospital‐acquired complications need to be developed and evaluated. 14 , 20 …”

Section: Discussionmentioning

confidence: 99%

“…Non-serious low back pain admissions had a postprocedural complication rate of 2.3% (T80-T88, G97, M96), compared with in 4% of all admissions. 67 [20] 64 [19] 72 [18] 71 [18] 71 [17] 68 [ Combined spinal surgical procedures occurred in 6.8% of the subsample, and perineural cortisone injection in 2.1% (see Table S3).…”

Section: Hospital-acquired Complicationsmentioning

confidence: 99%

Management of patients with low back pain admitted to hospital: An observational study of usual care

et al. 2022

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Background Knowledge gaps exist around diagnostic and treatment approaches for patients admitted to hospital with low back pain. Methods Medical record review of patients admitted to three Sydney teaching hospitals with a provisional emergency department diagnosis of non‐serious low back pain, from 2016 to 2020. Data on demographic variables, hospital costs, length of stay (LOS), diagnostic imaging and analgesic administration were extracted. Logistic regression was used to identify predictors of longer hospital stay, advanced imaging, and concomitant use of sedating medicines. Results Median inpatient LOS for non‐specific low back pain was 4 days (interquartile range [IQR] 2‐7), and for radicular low back pain was 4 days (IQR 3‐10). Older patients with non‐serious low back pain were more likely to stay longer, as were arrivals by ambulance. Plain lumbar radiography was used in 8.3% of admissions, whereas 37.6% of patients received advanced lumbar imaging (computed tomography or magnetic resonance imaging). Opioids were administered in ~80% of admissions; 49% of patients with radicular low back pain were given an antiepileptic in addition to an opioid. In all, 18.4% of admissions resulted in at least one hospital‐acquired complication, such as an accidental fall (3.1%) or a medication‐related adverse effect (13.3%). Physiotherapists saw 82.6% of low back pain admissions. Costs of inpatient care were estimated at a mean of AU$ 14 000 per admission. Conclusions We noted relatively high rates of concomitant use of sedating pain medicines and referrals for advanced lumbar imaging and laboratory tests. Strategies to address these issues in inpatient care of low back pain are needed.

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Many people admitted to hospital with a provisional diagnosis of nonserious back pain are subsequently found to have serious pathology as the underlying cause

et al. 2022

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To determine the proportion of patients admitted to the hospital for back pain who have nonserious back pain, serious spinal, or serious other pathology as their final diagnosis. The proportion of nonserious back pain admissions will be used to plan for future ‘virtual hospital’ admissions. Electronic medical record data between January 2016 and September 2020 from three emergency departments (ED) in Sydney, Australia were used to identify inpatient admissions. SNOMED-CT-AU diagnostic codes were used to select ED patients aged 18 and older with an admitting diagnosis related to nonserious back pain. The inpatient discharge diagnosis was determined from the primary ICD-10-AM codes by two independent clinician-researchers. Inpatient admissions were then analysed by sociodemographic and hospital admission variables. A total of 38.1% of patients admitted with a provisional diagnosis of nonserious back pain were subsequently diagnosed with a specific pathology likely unsuitable for virtual care; 14.2% with a serious spinal pathology (e.g., fracture and infection) and 23.9% a serious pathology beyond the lumbar spine (e.g., pathological fracture and neoplasm). A total of 57% of admissions were identified as nonserious back pain, likely suitable for virtual care. A challenge for implementing virtual care in this setting is screening for patients with serious pathology. Protocols need to be developed to reduce the risk of patients being admitted to virtual hospitals with serious pathology as the cause of their back pain. Key Points• Among admitted patients provisionally diagnosed in ED with non-serious back pain, 38.1% were found to have ‘serious spinal pathologies’ or ‘serious pathologies beyond the lumbar spine’ at discharge.• Spinal fractures were the most common serious spinal pathology, accounting for 9% of all provisional ‘non-serious back pain’ admissions from ED.• 57% of back pain admissions were confirmed to be non-serious back pain and may be suitable to virtual hospital care; the challenge is discriminating these patients from those with serious pathology.

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Virtual hospitals: why we need them, how they work and what might come next

Cited by 5 publications

References 12 publications

Systematic review of predictors of hospitalisation for non-specific low back pain with or without referred leg pain

Systematic review of predictors of hospitalisation for non-specific low back pain with or without referred leg pain

Management of patients with low back pain admitted to hospital: An observational study of usual care

Many people admitted to hospital with a provisional diagnosis of nonserious back pain are subsequently found to have serious pathology as the underlying cause

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