Stewart V, Rosbergen I, Tsang B, Hoffman A, Kwan S, Grimley R. Do Vestibular Physiotherapy and a Clinical Pathway in the Emergency Department Improve Management of Vertigo?
OTO Open 2022;
6:2473974X221119163. [PMID:
35990816 PMCID:
PMC9382073 DOI:
10.1177/2473974x221119163]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 11/22/2022] Open
Abstract
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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