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Post 75. PT in the ED

“Between 2000 and 2011, the number of ED visits in the United States rose by 26%, and this trend is expected to continue with implementation of the affordable care act.… Nearly 30% of hospital-based EDs have closed since 1990”
Essentially, this means that more and more people are using the emergency department, but staff sizes aren’t increasing as much as they should be according to the increase in usage. With the addition of the affordable care act, more people are insured. Although this sounds good, the reimbursement rate for providing the same service from last year has gone down this year.
Rant: this just chaps my ass. How many different businesses will allow the customer to pay less next year than they did this year? I would love it if the price of milk kept dropping year-over-year unfortunately for healthcare providers the value of saving lives has gone down year to year.

“…nearly half of all ED visits can be classified as semiurgent (35%) or nonurgent (8%).”

This means that the “emergency department” is no longer used for emergencies. This takes resources away from those that are urgent in order to treat those that are not as urgent. The article speaks of using ED physicians to treat sprains and strains, which could be treated by a primary care physician’s office.

 

“With increasing numbers of patients seeking care in EDs for nonurgent musculoskeletal conditions, physical therapists have the knowledge and skills required to play an increased role in the primary care of patients and to help mitigate overcrowding and improve time efficiency in the current ED environment”

This was a mouthful. The authors are making the assumption that the types of patients presenting to the emergency department will not change. This means that almost half of the patients coming into the ED do not actually need “emergency” services. Because of this, PT’s can play a major role in assessing and treating musculoskeletal conditions. Doing so would take the resources (emergency physicians) and allow these services to be directed towards the patients that need this service specifically. This would reduce wait times in the ED. Having been to the ED at times with my daughter (one of the prices of being a new parent), I totally agree that wait times can be a deterrent to going to the ED. For some problems though, we can’t wait.  

“This practice (physical therapists in the ED) was first described in the United States in 2000 and was identified as an ‘emerging practice’ by the American Physical Therapy Association.”

My specific hospital started using PT’s in the ED and I am proud to say that I was part of the catalyst for starting this program. We go up to the ED in order to assess spinal pain and balance/vestibular conditions. I find that our opinion is valued as a consultation by the ED physicians, but I have no objective data to back up that belief.

“Physical therapists function as secondary practitioners and require referrals from medical doctors to examine and treat patients”

This is true to an extent. PT’s in this state I practice require a referral in order to treat a patient, but not to evaluate a patient. This is not true for every state, as each state has its own practice act.  

“Physical therapist practice in the IUMH (Indiana University Methodist Hospital) ED began in 2002 with one full-time physical therapist…evaluate more than 2,000 patients annually”

In the hospital from the study, the article notes that the total number of hours of PT’s working in the ED has increased over time. This is not the case yet in our hospital, as the therapists are essentially “on-call” in the ED from their respective locations in the hospital. For instance, I work in the outpatient setting, but when there is need for a spine evaluation, I get called to go upstairs when needed/able.

“The reason for dissatisfaction reported in both cases (both from staff physicians) was that the ED physical therapist was not available at the time the physician sought to refer a patient”

This is the only reason for being dissatisfied?! This is a great sign for the future of PT’s in the ED.

“…the following 3 items were rated as most valuable in both 2004 and 2011: (1) provide specific instructions regarding the proper and safe use of assistive devices; (2) provide interventions that are an alternative to pain medication; (3) educate patients regarding injury prevention, safety, and body mechanics with daily activities.”

We look at gait training and think that it is easy. We are trained very well to do this and should take ownership over performing gait training and gait analysis. As PT’s, especially outpatient PT’s, gait training with an AD is something that should be done before a patient gets to outpatient, but this is a part of our profession. We should not allow other professions to own this. In taking ownership, this needs to be done for all patients that need the assistive device, regardless of setting.

Pain management seems to be pushed hard in the media now, as there is an opioid epidemic. As therapists, we can educate on the hurt vs harm mentality. Patients need to understand the difference. Unfortunately, pain can cause patients to become fearful. This places the patient into a cycle in which any activity that causes pain should be avoided. This will only prolong the cycle of pain.  

I don’t believe that there is any other profession that can assess body mechanics with as much depth as PT. 
The end result of the article is that physicians are pleased with PTs in the ED and note that PTs are the most qualified to assess body mechanics, gait training, and return to work. The chief gripe was lack of availability of PTs when requested. This is another avenue for hospitals to increase revenue, as this is considered an outpatient visit. 
Fruth SJ, Wiley S. Physician Impressions of Physical Therapist Practice in the Emergency Department: Descriptive Comparative Analysis Over Time. Phys Ther. 2016;96:1333-13341

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Categories: Physical therapy

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