Do Vestibular Physiotherapy and a Clinical Pathway in the Emergency Department Improve Management of Vertigo?
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Author(s)
Stewart, V
Rosbergen, I
Tsang, B
Hoffman, A
Kwan, S
Grimley, R
Griffith University Author(s)
Year published
2022
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Objective: Determine the effects of a vertigo/dizziness emergency department (ED) clinical pathway incorporating vestibular physiotherapy on quality and efficiency of care. Study Design: A multisite retrospective study investigated differences between cohorts before and after a vertigo clinical pathway and cohorts who did and did not receive vestibular physiotherapy assessment. Setting: Adults presenting to 2 Australian EDs with symptoms clinically consistent with vestibular disorder were captured via ED diagnostic code screening and subsequent medical record review. Methods: Medical record audits obtained quality of care ...
View more >Objective: Determine the effects of a vertigo/dizziness emergency department (ED) clinical pathway incorporating vestibular physiotherapy on quality and efficiency of care. Study Design: A multisite retrospective study investigated differences between cohorts before and after a vertigo clinical pathway and cohorts who did and did not receive vestibular physiotherapy assessment. Setting: Adults presenting to 2 Australian EDs with symptoms clinically consistent with vestibular disorder were captured via ED diagnostic code screening and subsequent medical record review. Methods: Medical record audits obtained quality of care indicators: diagnosis, HINTS (head impulse–nystagmus–test of skew), and vestibular physiotherapy management. Linked hospital administrative data sets provided efficiency measures: time from ED presentation to assessments, hospital admission rates, and ED and total hospital length of stay. Results: Postpathway cohorts (n = 329) showed greater use of HINTS (by 27%; 95% CI, 21%-33%), more frequent vestibular physiotherapy assessment (by 27%; 95% CI, 20%-33%), reduced wait time to assessment (25.0 to 4.6 hours; 95% CI, −27.1 to −14.1), and reduced ED length of stay (3.9 to 3.2 hours; 95% CI, −0.3 to −1.0) as compared with prepathway cohorts (n = 214). When compared with those not receiving vestibular physiotherapy assessment, patients assessed by a vestibular physiotherapist (n = 150) received a specific diagnosis more frequently (65% vs 34%; 95% CI, 22%-40%) but were admitted more often (79% vs 49%; 95% CI, 22%-38%) with longer total hospital length of stay (13.0 vs 5.0 hours; 95% CI, 6.1-10.6). Conclusion: An ED vertigo clinical pathway was associated with improved quality and efficiency of care, including reduced ED time. Vestibular physiotherapist assessment was associated with greater diagnostic specificity but higher hospital admissions.
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View more >Objective: Determine the effects of a vertigo/dizziness emergency department (ED) clinical pathway incorporating vestibular physiotherapy on quality and efficiency of care. Study Design: A multisite retrospective study investigated differences between cohorts before and after a vertigo clinical pathway and cohorts who did and did not receive vestibular physiotherapy assessment. Setting: Adults presenting to 2 Australian EDs with symptoms clinically consistent with vestibular disorder were captured via ED diagnostic code screening and subsequent medical record review. Methods: Medical record audits obtained quality of care indicators: diagnosis, HINTS (head impulse–nystagmus–test of skew), and vestibular physiotherapy management. Linked hospital administrative data sets provided efficiency measures: time from ED presentation to assessments, hospital admission rates, and ED and total hospital length of stay. Results: Postpathway cohorts (n = 329) showed greater use of HINTS (by 27%; 95% CI, 21%-33%), more frequent vestibular physiotherapy assessment (by 27%; 95% CI, 20%-33%), reduced wait time to assessment (25.0 to 4.6 hours; 95% CI, −27.1 to −14.1), and reduced ED length of stay (3.9 to 3.2 hours; 95% CI, −0.3 to −1.0) as compared with prepathway cohorts (n = 214). When compared with those not receiving vestibular physiotherapy assessment, patients assessed by a vestibular physiotherapist (n = 150) received a specific diagnosis more frequently (65% vs 34%; 95% CI, 22%-40%) but were admitted more often (79% vs 49%; 95% CI, 22%-38%) with longer total hospital length of stay (13.0 vs 5.0 hours; 95% CI, 6.1-10.6). Conclusion: An ED vertigo clinical pathway was associated with improved quality and efficiency of care, including reduced ED time. Vestibular physiotherapist assessment was associated with greater diagnostic specificity but higher hospital admissions.
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Journal Title
OTO Open
Volume
6
Issue
3
Copyright Statement
© The Authors 2022. This Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 License (http://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Subject
Physiotherapy
Emergency medicine
dizziness
efficiency
emergency department
physiotherapy
vertigo