Physical therapy role in an emergency department

Original Editor - Ayelawa Samuel Top Contributors - Claire Knott, Ayelawa Samuel, Jeremy Bryan, Lucinda hampton, Alicia Fernandes, Kim Jackson, Amanda Ager and Amal Abbasi

Introduction

Please note that this page is about the roles and responsibilities of physiotherapists / physical therapists (PTs) in the emergency department, once the patient has been seen and admitted by triage.

For a look at the roles and responsibilities of PTs within the triage system, click here.

Physiotherapy or physical therapy provision in the hospital emergency department (ED) is a growing area of practice. Physical therapists can help patients start on the road to recovery early in the injury process, facilitating the possibility to improve outcomes in certain injury types. Patients receiving physical therapy care in the ED can benefit from the physical therapist’s expertise in musculoskeletal, respiratory, and vestibular conditions. This primary contact consultation can help to ease the burden of delay in treatment in the busy ED environment as well as decrease hospital length of stay and resources usage.

Avoiding Unnecessary Hospital Admissions

In some cases, patients coming to the ED may not require inpatient hospital care from a medical standpoint, while at the same time presenting as potentially unsafe (in terms of mobility) to discharge home. Often, in these cases, patients will be admitted to the hospital anyway, solely to be evaluated by a Physical Therapist for discharge planning. This is where Physical Therapist evaluations in the emergency department can be utilized.

Gurley et al. examined around fourteen hundred ED patients, from multiple hospitals, with orders placed for Physical Therapist evaluations in the ED. Of these fourteen hundred patients, roughly two thirds where ultimately either discharged home with or without additional therapy services or discharged to a rehabilitation facility. The authors concluded that these patients presumably avoided hospital admissions by receiving a Physical Therapist evaluation in the ED.

The emergency department physiotherapist would typically be assigned the following types of presentations from triage:

• soft tissue injuries (sprains and strains)
• simple fractures
• mobility assessment
• stable respiratory conditions or respiratory exacerbations
• vertigo
• secondary care following clinician assessment
• spinal disorders
• Arthropathies
• Cerebrovascular Diseases

The range of assessment that can be conducted by physiotherapists varies depending on the location and experience of the therapist. Some departments will allow physiotherapists to take over care of a patient directly from triage (primary contact) whereas other locations may require clinician assessment before treatment by physiotherapy (secondary contact via referral). In terms of requesting imaging or providing intervention, this can also vary greatly. In some locations in Australia, suitably qualified and competent ED PTs may request imaging and even prescribe medications whereas at other locations, the patient is to be handed back to the speciality clinician with findings to dictate the pathway of care.

Common interventions that are provided by physiotherapists in ED include:

• Patient education about their injury or illness and the trajectory of healing or condition management
• Instruction in bed mobility, transfers and walking
• Instruction in using assistive devices such as a walking stick, crutches or a walker
• Prescribe exercises to help treat conditions
• Provide pain relief such as ice or heat for injury and compression bandaging
• Provide suitable immobilisation for fractures and ligamentous injury such as backslabs, moon boots and splints

Non opioid Alternative

Reducing opioid dependence in emergency departments (EDs) is crucial, particularly as musculoskeletal disorders (MSKD) increasingly drive patients to seek care in these settings . Despite guidelines suggesting otherwise, many MSKD patients are discharged from EDs with opioid prescriptions, contributing to Canada's opioid crisis . This overreliance on opioids stems from limited training among ED physicians in managing non-life-threatening conditions like MSKD .

However, physiotherapists (PTs) offer a promising alternative. Studies have shown that PT-led care in EDs results in fewer opioid prescriptions and better outcomes for MSKD patients . PTs provide non-pharmacological approaches to pain management, addressing the root causes of pain and reducing the need for opioids . Moreover, PTs demonstrate high diagnostic agreement with ED physicians, ensuring that serious pathologies are not missed .

The ongoing multicenter pragmatic trial assessing Advanced Practice Physiotherapy (APP)-led ED care represents a significant advancement in evaluating new models of care . However, the experimental nature of the trial may not fully reflect usual care, and patients' awareness of the trial objective could influence their perceptions .

In conclusion, integrating physiotherapy into ED care for MSKD presents a promising solution to the opioid crisis. By offering non-pharmacological approaches to pain management and addressing the root causes of pain and dysfunction, physiotherapists play a vital role in reducing opioid dependence and improving outcomes for MSKD patients in emergency departments.