Friday, August 17, 2018 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.