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  • PTs in the ED: Australian Study Supports Role of PTs as Primary Patient Contact in Certain Cases

    A new study from Australia has found that when physical therapists (PTs) serve as a primary patient contact in emergency departments (EDs), use of imaging and patient length of stay drop—all without an increase in adverse events.

    The 12-month research project analyzed outcomes of 9,037 patients who presented to an ED in 2012, at a time when Australia was investigating "expanded roles for non-medical practitioners," according to the study's authors. After being assigned ICD 9 codes, and evaluated as to whether those codes were "appropriate" for treatment by a PT, patients were divided into 2 groups: 1,249 patients received treatment managed by a PT, and 7,788 were treated by "usual medical staff."

    Conditions deemed appropriate for PTs to manage in the ED included closed limb fractures, nontraumatic spinal pain, and soft tissue conditions including strains and sprains. The study found that 12.9% of all people presenting to the ED "had ICD-9 codes suitable to be managed by a physiotherapist." Results were published in the Journal of Physiotherapy (.pdf).

    Researchers looked at "adverse events" that may have surfaced through re-presentations to the ED within 28 days, consumer complaints, and reports to a local safety reporting system, and found no evidence of adverse events from the PT group. Although there were 33 re-presentations in the 28-day window, authors write that none "were due to incorrect diagnosis or missed fracture."

    When the researchers turned to length of stay and use of imaging (a data point that authors believe contributes to longer stays), they found some significant differences between the PT and non-PT groups.

    On average, the patients whose primary contact was the PT remained in the ED 83 fewer minutes than the patients seen by usual medical staff—an average of 103 minutes compared with 185 minutes. When it came to imaging, PTs ordered fewer x-rays, CT scans, and ultrasounds than the other providers.

    Researchers also analyzed the imaging statistics in terms of "number needed to treat," and found that for every 8 patients managed by the PT, 1 x-ray was avoided. That rate was 1 CT scan avoided for every 40 patients under the care of the PT, and 1 ultrasound avoided for every 69 patients seen by the PT.

    Authors acknowledge limitations to their study, including the fact that the PT option was only available during daytime hours, and that the research lacked data on whether the patients presenting to the ED had diagnostic imaging from somewhere else. Still, they write, "the physiotherapy service was able to identify appropriate patients and provide safe management without any identified adverse events or misdiagnoses."

    "These outcomes have potentially important implications, particularly in the context of increasing pressures on [EDs] across Australia," authors write.

    APTA supports the critical role of the PT in the ED, and offers a wide range of resources on the topic at its Physical Therapist Practice in the Emergency Department webpage.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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