Occupational Medicine Advance Access originally published online on August 21, 2008
Occupational Medicine 2008 58(7):485-489; doi:10.1093/occmed/kqn097
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Do occupational health assessments match guidelines for low back pain?
1 Department of Occupational Health, Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, UK
2 Department of Occupational Health, Central Manchester and Manchester Children’s University Hospitals NHS Trust, Manchester, UK
3 Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
4 Biostatistics Group, Health Methodology Research Group, School of Community Based Medicine, The University of Manchester, Manchester, UK
Background Audit is an important facet of clinical governance and good occupational health practice. There are well-established clinical guidelines for the management of low back pain. Occupational Health Guidelines for the Management of Low Back Pain at Work were launched by the Faculty of Occupational Medicine in March 2000, based on an extensive, systematic review of the scientific literature predominantly from occupational settings or concerning occupational outcomes.
Aim To determine whether documented National Health Service occupational health assessment of low back pain in the North West region of England conforms to the published guidelines.
Methods A retrospective audit of case notes was conducted. Six performance indicators were derived from the Occupational Health Guidelines for the Management of Low Back Pain at Work in order to evaluate the performance by occupational physicians. Two hundred and seventy-seven case notes were identified from eight different occupational health departments.
Results Low rates of compliance with national standards were observed for recording of some performance indicators, notably for the assessment and documentation of ‘red’ and ‘yellow flags’. Our findings suggest that the quality of documentation of key information in the notes leaves significant room for improvement.
Conclusions For future audits, we recommend having two external auditors and seek to demonstrate a high degree of agreement between observers by conducting a reproducibility exercise. Future Faculty guidelines should emphasize documentation of the assessment and perhaps consider assessment tools to improve documentation.
Keywords Audit; back pain; guidelines; occupational health
Correspondence to: Luke Walsh, Mediscreen Occupational Health Service, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester M8 5RB, UK. Tel: +44 161 720 2727; fax: +44 161 720 2728; e-mail: luke.walsh{at}pat.nhs.uk