Building a physical therapy program in the emergency room setting includes engaging stakeholders, estimating clinical volume, and finding qualified therapists.
Emergency department physical therapy (ED PT) offers multiple benefits and is poised to spread across the country, researchers say.
Physical therapists augment ED care teams, the researchers reported this month in the American Journal of Emergency Medicine.
"Patients receiving ED PT benefit from the physical therapist's expertise in musculoskeletal and vestibular conditions and from the individualized attention provided in a typical bedside evaluation and treatment session, which includes education on expected symptom trajectory, recommendations for activity modulation, and facilitated outpatient follow-up," the researchers wrote.
While common in Australia and the United Kingdom, ED PT has established a modest foothold in the United States, with programs at 23 health systems as of 2014.
The researchers say there are three key steps to create an ED PT program: engaging stakeholders, estimating clinical volume, and staffing PT positions with qualified professionals.
1. Stakeholder engagement
Most ED physical therapists are drawn from a health system's or hospital's physical therapy department because using existing organizational infrastructure is often the most efficient option, the researchers wrote.
"Engagement with physical therapy departmental leadership is a foundational step in establishing an ED PT program."
Engaging the ED leadership is also essential because PT services are provided in ED patient rooms or hallways.
Bed capacity is a potential stumbling block to engaging ED leadership, who can be concerned that prolonged patient stays reduce bed capacity. Timely PT consults are the solution, the researchers wrote.
"We posit that prolonged lengths of stay likely reflect a delay in initiating the PT consultation request, and a formal workflow for early PT consultation is likely to make this process more efficient."
Finally, ED care providers such as resident and attending physicians, nurse practitioners, physician assistants, and registered nurses should be consulted to gauge their support for an ED PT service.
2. Clinical volume estimation
The researchers highlight physical therapy visit data at several EDs.
On the low end of the scale with one full-time physical therapist in the ED, Barnes-Jewish Hospital in St. Louis posted 565 annual PT ED visits in 2009 with an annual ED-visit census of 62,000.
On the high end of the scale with two full-time physical therapists, Indiana University Methodist Hospital in Indianapolis posted 2,000 annual PT ED visits in 2014 with an annual ED-visit census of 102,000.
"The experience of these ED PT programs may indicate that consult volume is constrained by the number of FTE physical therapists rather than annual ED census," the researchers wrote.
3. Physical therapist qualities
Strong communication skills are essential for ED physical therapists, the researchers wrote.
"An ideal ED physical therapist will have good patient communication skills, given the volume of information that patients are likely to receive in a short period of time from the ED care team."
Mirroring a crucial ER physician skill, ED physical therapists must be flexible and improvisational, the researchers wrote.
"ED physical therapists must also function as a 'jack-of-all-trades' and should therefore have a wide range of clinical skills that can be adapted to address the variety of patient problems encountered in the acute care setting."
PT ED: Clinical Care
Physical therapy has three primary clinical applications in the ED:
- Acute musculoskeletal injuries are most frequently neck or back pain, but also include hip, knee and shoulder pain.
- With training in vestibular conditions, physical therapists are well-suited to treat peripheral vertigo, such as giving patients self-directed therapeutic maneuvers and assessing discharge safety.
- Gait training and assessment in the ER is a prime service area for physical therapists, with several clinical applications including home safety and disposition planning for orthopedic devices such as crutches and knee scooters.
ED PT programs are generating positive results, the researchers wrote.
"Initial reports from U.S. hospital systems that have established ED PT services have cited increased provider and patient satisfaction, decreased wait times, and decreased rates of admission to the hospital for patients with orthopedic conditions."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Physical therapists augment ED care teams for several conditions such as musculoskeletal pain.
Top stakeholders in ED physical therapy programs include physical therapy departments and ED leadership.
ED physical therapists must have good communication skills and clinical flexibility.