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  • Study: Emergency Department PTs Are Just What the Doctor Ordered

    More hospitals should incorporate physical therapists (PTs) into their emergency department (ED) workflow, say authors of a review in the American Journal of Emergency Medicine (abstract only available for free). Hospitals that have done so already, they write, have seen “positive impacts in clinical care and patient and physician satisfaction” due to PT expertise, “extended bedside care,” and patient education.

    Researchers examined the typical ED PT practice patterns and clinical outcomes, intangible impacts of ED PT services, and considerations for building an ED PT program. Study coauthors include APTA members Kyle J. Strickland, PT, and Michael T. Lebec, PT, PhD.

    According to the authors, ED PTs are most often consulted for patients with acute musculoskeletal issues, not only to provide patient education and develop a plan of care for these conditions, but to help physicians make a more specific diagnosis to begin with. “Nearly half of all medical schools do not require curriculum in musculoskeletal medicine,” authors write, adding that emergency medicine training is geared toward identifying and managing life-threatening conditions.

    According to preliminary reports, hospitals with ED PT programs have noticed increased patient and provider satisfaction, decreased wait times, and decreased admission rates for patients with orthopedic symptoms.

    Physical therapists also may be consulted for patients with suspected peripheral vertigo after a physician has excluded more serious causes. Due to the protracted assessment time for such patients, PT involvement and expertise takes some of the burden off physicians who cannot devote uninterrupted time.

    Emergency department PTs are increasingly being called to assist with gait training and patient disposition planning. The ED physicians who have access to PTs cite PT evaluation of patient mobility and safety as “a significant added value,” authors write.

    Authors hypothesize that the inclusion of ED physical therapist services also may increase workplace satisfaction, improve patient flow, decrease opioid usage, reduce unnecessary diagnostic imaging, decrease downstream health care utilization, and prevent unnecessary hospitalization.

    Hospitals wishing to create such a program can learn from the experiences of existing programs, authors suggest. Important steps in implementation “include engaging with key stakeholders in physical therapy and emergency medicine, estimating initial clinical volume and staffing needs, and targeting appropriate personnel for the unique practice environment of the ED,” they write.

    "This review is consistent with a position that APTA has supported for several years—that PTs have an important role to play in the ED," said Anita Bemis-Dougherty PT, DPT, MAS, APTA's vice president of practice. "In 2008, the association's House of Delegates adopted a position promoting physical therapy as a professional service in the emergency care environment, but that official statement reflected beliefs that were widely shared in the profession for some time." The official House motion can be found here. In addition, APTA offers a webpage on the topic that includes an online toolkit, a video, and links to resources from the US Department of Health and Human Services.

    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.

    Comments

    • Really appreciate what you wrote here. I'm also a PT. Hope that I could read more of your editorials.

      Posted by Hector de Guzman on 8/18/2018 12:30 AM

    • This article is great EXCEPT you used "doctors" as referring to physicians. If our profession wants to be on the same playing field as other doctoring health professions, we need to be more mindful of the terms we use. Otherwise we will always be considered second tier to physicians. APTA needs to do a better job promoting our doctoring profession, rather than demoting us whether it is intentional or unintentional. Please consider stating "medical doctor" or "physician" if you are referring to MDs. Otherwise, you will only be contributing to the confusion that patients and other health professionals have regarding our current education. Respectfully, Sandra Hon, DPTc, MSc

      Posted by Sandra Hon on 8/18/2018 6:08 PM

    • Allowing ancillary professionals to function to the maximum ability of their licensure 1. decreases physician workload, 2. assists physicians in ordering ongoing treatment directed to the complaint, 3. begins treatment immediately, 4. let's the patient leave feeling that something has been done, 5. and may well decrease prescribing narcotics as the patient can be shown alternatives.

      Posted by Serenecharleen on 8/18/2018 9:25 PM

    • I would like to add my perspective: referring to licensed healthcare professionals, who have achieved an academic or clinical doctorate level degree, as "ancillary" also (consciously or not) propetuates an archiac, dismissive attitude that is insensitive to the fact that these government-classified "ancillary" doctors are mostly women in female-dominated healthcare doctoring professions (e.g. nursing doctors, physical therapy doctors). According to one Merriam-Webster dictionary definition: "Ancillary" derives from the English word "ancilla," a somewhat rare word that means "an aid to achieving or mastering something difficult." That word derives from Latin, where it meant "female servant." I simply cannot view myself as "ancillary" because the notion is incompatible with my concepts of what a healthcare doctor is - a person who holds a doctorate and who is licensed in one of the healing arts - and what a woman is not - a servant. Can you?

      Posted by Lise McCarthy, PT, DPT, GCS on 8/19/2018 2:35 PM

    • I understand there are residency programs out there for PT's interested in gaining more experience. Does anyone know where to find out where these are???

      Posted by Kristine on 8/22/2018 8:15 PM

    • There is no residency in ED that I know of. But there is a very interactive Facebook group, ED PT.

      Posted by Kyle Knauff, DPT, OCS on 8/22/2018 10:45 PM

    • Here is the Facebook emergency PT group Dr. Knauff mentioned above: https://www.facebook.com/groups/EDPT1/

      Posted by Carleen Jogodka -> ?IQbEN on 8/31/2018 3:03 PM

    • Kristine, You can go to this link to find more information about residency programs: http://www.abptrfe.org/ResidencyPrograms/ I recently completed a geriatric residency at Cincinnati VA Medical Center and there is a specialty board certified PT who see's patients in the ED. Although there are no ED residency, you may find a program where you have the opportunity to gain experience in the ED. Hope this helps!

      Posted by Roslyn Burton -> @NY[CK on 9/5/2018 4:23 PM

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