P hysical therapists in the emergency department (ED), is that a thing? I wondered this because when I was in graduate school I had never heard of PTs utilized in such a capacity. Upon completing an acute care clinical at an academic hospital, a few times we were called to the ED to assist with gait training and post-op lumbar surgery patients; a novel concept to a new student.
Recently, a couple of studies have reported on the benefits of having physical therapists in the emergency department. PTs looked at in these studies have dealt with musculoskeletal issues (such as low back pain), neuromuscular issues (falls, gait training), and vestibular issues. One general study on the use of PTs in the ED has shown positive benefits such as increased patient satisfaction, reduction in wait times, and less admissions for those with orthopedic diagnoses. This study also mentions the ability for PTs to discuss patient education, need for physical therapy physician referral, and other prognoses more thoroughly for transition to outpatient physical therapy.
As of 2014; however, only 23 hospitals noted utilizing physical therapy services. Most common diagnoses noted by the programs utilizing ED PTs were lumbar and cervical pain.It is also worth mentioning that this article looks at PT utilization within the US healthcare model, as international ED PTs are the primary providers for patients that present to the ED with lower extremity musculoskeletal issues. Noting therefore that the US-based physical therapist is considered a secondary provider, and that most medical school (50%) education does not require courses in musculoskeletal examination, it is not surprising that PTs are able to offer a wealth of knowledge to the orthopedic patient, so that the ER physician skill set is better directed towards more emergent cases.
Along with orthopedic cases, ED PTs also assist with vestibular referrals. ED PTs may reduce the need for unnecessary imaging/neuro consultation and are also able to demonstrate specific maneuvers the patient can complete at home, thus better allocating healthcare costs. The ability for PTs to spend more one-on-one time with the patient (approximately 45 minutes in those with PT ED programs), as opposed to the multiple, often more emergent demands on the ER physician, allows for a more detailed examination of the patient, thus reducing the need for unnecessary imaging/referrals as noted above.
A study on multi-disciplinary teams created for the aging population has also shown decreased ED admissions as PTs are able to select more appropriate outcome assessments and assess transfer/gait abilities. Another added value noted is the aid in disposition planning as the study notes increased ease of placement and more appropriate placement for follow-up care. Along with disposition planning, the article also mentions increased patient satisfaction from the use of PTs in the ED due to the patient having increased time with a healthcare provider, better diagnosis of complex musculoskeletal problems, and more expedient disposition transfer. This assistance, the ED physicians noted, freed up time for them to care for other emergent patients as well.
Another ED study looked at the utilization of physical therapists in those admitted for the primary diagnosis of falls. This study stated a 35% reduction in the number of revisits after an initial fall within 30 days, that number reduced slightly to 32% after 60 day follow-up (as opposed to no PT consult). “At 30 days, 1.7% of the PT group had revisited the ED for a fall, compared with 2.6% of the non-PT group; at 60 days, the rate was 2.6% for the PT group, compared with 3.6% of the non-PT group.” Factors that increased revisits for falling included being a male, Medicaid insurance, and co-morbidities (significantly Alzheimer’s). The study also notes the under-utilization of PT services as “Only 3.2% of older adults presenting for a fall-related ED visit received PT services during that visit, according to claims data.” Of note, this study only looked at PT utilization at initial evaluation and did not screen for physical therapy in the outpatient setting between ED visits.
As noted in the studies listed above, physical therapy offers benefits in the ED that can not only allow for increased patient and physician satisfaction, but also allow more appropriate allocation of resources along with a reduction in re-visits after falls. With the increasing number of ED visits (51% increase in ED visits from 2003-2013), and the aging population, PT services may be utilized further in the future as an adjunct to the emergency department.
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