Physical therapy in the emergency department can provide benefits to patients, hospitals, and physicians. It can improve patient satisfaction by reducing wait times and providing education and referrals. It also saves costs by decreasing unnecessary imaging, medication use, and hospital admissions and readmissions. Physical therapists in the ED can help increase productivity by allowing physicians and nurses to focus on other patients while PT evaluates and treats musculoskeletal injuries, falls, balance issues, and more. The document outlines the process for PT referrals and evaluations in the ED, areas of training for ED physical therapists, and physician perspectives on the benefits of PT in emergency care.
6. +
Types of Conditions managed by ED
PT’s
MSK injuries
Peripheral vestibular dysfunction
Acute or chronic wound care
Injury from fall/fall prevention
Neurological deficits
(Childs, 2005; Lebec, 2009;
Smith, 2010; Alghadir, 2012)
7. +
PT Scope of Practice in ED
Differential diagnosis
Patient education
Discharge planning
Pain management
Exercise prescription
Safety assessment
(APTA Guide; Lebec, 2009; Alghadir, 2012)
8. +
Physician Perspectives
“I think that the services are an unrecognized need. I certainly
never would have sought out PT services for the department, and
I’m the medical director… But now that they’re here I can’t
imagine working in a department without them”
“Physical therapists are particularly good at sorting out
musculoskeletal problems that we are not well trained to do”
“Able to provide a more comprehensive diagnosis and treatment
plan than was the norm in the ED”
(Lebec, 2010)
9. +
Process to initiate PT evaluation
1. MD
assessment &
r/o life
threatening
conditions
2. MD/RN refers
to guidelines for
PT consults
3. MD/RN places
electronic order if
appropriate: PT
Eval & Treat
4. ED notifies PT
ASCOM x 2357
5. PT goal: Assess
patient <30 minutes
of phone call.
*Certain situations
will not allow for PT
consult.
6. PT performs
eval & treatment
as appropriate,
discussion of
findings w/ MD &
RN
7. Goal: d/c from
ED (home, IP,
etc)
10. +
Guidelines Patient cleared for all emergent cardiac
issues, all possible emergent
neurological issues, and any possible
fractures?
Suspect
Musculoskeletal
Issues?
Proper Imaging
performed (Ottawa
Ankle/Knee Rules,
Canadian C-spine Rules)
If cleared for fractures
then consult PT to
evaluate and treat
Unsafe to Discharge
Home?
Consult PT if unsure
Suspect Vertigo,
dizziness, or “off
balance”?
Any medication interaction
or incorrect dosages? If
yes, proper consult with
MD or pharmacy.
No
Consult PT for
Vestibular Eval and
Treat
History of Falls?
Consult PT for balance
assessment and safety
recommendations
Suspect other neuro:
Parkinson’s, MS, etc.?
Is patient already
receiving therapy
services?
If not receiving
services then consult
PT at HRRMC
11. +
Areas of Training for PT
Non-clinical skills
Differential diagnosis
Orthopedic management
Wound care management
Mobility/fall risk assessment
Neurovestibular
Pain management
Radiology
Pharmacology
12. +
Recommended Experience
1-3 years post graduation clinical experience
Experience in acute care or emergency setting
Residency program (optional)
13. +References
1. American Physical Therapy Association. Guide to Physical Therapist Practice. Second Edition.
Phys Ther. 2001;81:9-746.
2. Alghadir AH, Iqbal ZA, Whitney SL. An update on vestibular physical therapy. J Chin Med
Assoc. 2012;76:1-8.
3. Lebec MT, Cernohous S, Tenbarge L, Gest C, Severson, K, Howard, S. Emergency Department
Physical Therapist Service: A Pilot Study Examining Physician Perceptions. The International
Journal of Allied Health Sciences and Practice. 2010; 8:1-12.
4. Lebec MT, Jogodka CE. The Physical Therapist as a Musculoskeletal Specialist in the
Emergency Department. Journal of Sports Physical Therapy. 2009;39:221-229.
5. Smith BA, Fields CJ, Fernandez N. Physical Therapists Make Accurate and Appropriate
Discharge Recommendations for Patients Who are Acutely Ill. Phys Ther. 2010; 693-703.
6. Childs JD, Whitman JM, Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical
therapists’ knowledge in managing musculoskeletal conditions. BMC Musculoskelet Disord.
2005;6:32.
7. Fleming-McDonnell D, Czuppon S, Deusinger SS, Deusinger RH. Physical Therapy in the
Emergency Department: Development of a Novel Practice Venue. Phys Ther. 2010;90:420-
426.
8. Morris CD, Hawes SJ. The value of accident and emergency based physiotherapy services. J
Accid Emerg Med. 1996;13:111-113.
Notas do Editor
Implement an evidence-based physical therapy program in the Emergency Department at HRRMC as an adjunct service in which both ED staff and patients recognize the value.
To establish a physical therapy service in the ED, two primary points will be addressed:
-Nationwide, avg wt times increased by an average of 1 hr. Time physicicians have for direct patient care decreased to an average of 6-7 minutes
-Through examination, evaluation and differential diagnosis, PT’s are able to decrease cost of unnecessary tests and services associated with diagnostic imaging, alternative pain management treatments, mobility interventions and possess expert knowledge on safe discharge options
-PT discharge recommendation not implemented, 2.9 times more likely to return within 72 hrs.
Pts seen in ED by PT had higher satisfaction ratings overall. (Lebec)
Nationwide, avg wt times increased to a national average of 1 hr. Time physicicians have for direct patient care decreased 36-41 min, with 6-7 min being hands on.
Pt’s report highter overall satisfaction in their experience, confidence in treatment provided and understanding of conditions.
Even though PT exams may take longer than MD in the ED the pts time in the waiting room will likely decrease (Fleming)
PT in the ED inc pt satisfaction with management of LBP and other MSK conditions (Fleming).
Pt ed such as safety awareness and mobility training is effective in reducing falls for at risk patients presenting to ED (MSK specialist, Smith)
Pt’s are more likely to be referred for OP care, creating the possibility of earlier return to work. (Lebec, Fleming)
Wait time between ED and OP was less for individuals seen by a PT in the ED. (Morris and Hawes)
When pts with specific MSK conditions were treated by PT treatment was less expensive then when orthopedic surgeons treated because imaging was ordered less (Fleming)
Pain management: cryotherapy, e stim, spinal manipulation
PT resources such as modalities, cryotherapy, and therapeutic exercise may be beneficial to address acute pain; early ex facilitates removal of edema, decrease pain, prevent disuse atrophy and restore normal movement (Lebec)
PT exam can avoid cast of hospital admission or injury resulting from inappropriate discharge to home; since pts are seeing rehab team early in intervention there is an increased likelihood that conditions will not become chronic and therefore more costly (Lebec)
Longer wait times leads to more admissions and longer hospital stays
For ankle sprains, some C spine injuries and LBP PT’s recommend mobility more often compared to ED physicians when appropriate. PT management of C spine, LBP and whiplash disorders in the ED have been found to be effective and cost-effective(Lebec)
PT’s more likely to give written instructions for self-management, structural support less often and refer more pts to OP services (Lebec)
APTA Guide to PT Practice
Alghadir
When PT recommendation for discharge was not followed and services were lacking, the readmission rate was 2.9 times higher at one hospital. (Smith)
Movement specialists: includes injury from fall
Other services: consultation for other ED specialists, manual therapy, splinting, wound care, vestibular interventions, and requests for imaging
Lebec 1
Benefit of PT
Safety assessments
Management of patients with vertigo
Pain management
Discharge recommendations
Patient education
Increased patient contact time
Enthusiastic Confident Active learner Flexible
Time management Lead PT
Persistent Good salesperson Diplomatic
