Physiotherapy in the Emergency Department

Background
• Physio’s relatively new in ED
• Variety of models of care
• Physio services have been shown to have a
good effect on patient satisfaction
(Bethel, 2005), (Anaf & Sheppard, 2007), (Kempson, 1996), (Lau et al, 2008)

Background
• Physio’s do manage MS injuries differently
to doctors and nurses (Ball et al, 2007)
• Physio’s target areas that would normally
impede discharge (Anaf et al, 2007)
• Physio services have had a positive effect
on waiting times
(Bethel, 2005), (Anaf & Sheppard, 2007), (Morris & Hawes, 1996)

Background
• Position funded by UDRH & RCS
• Aim:
– Provide clinical service to Tamworth Hospital
ED
– Provide opportunities for clinical education for
physiotherapy, medical, nursing and
radiography students
– Provide academic contribution to the UDRH &
RCS

Role
• Commenced in April 2009
– 5 physio students completed ED clinical units.
– Informal education of medical and nursing
students.
– Tutorials on management of MS conditions
and paediatrics to medical and physio
students.
– Inservices to medical and nursing staff in ED

Clinical Role
80%
70%
60%
50%
40%
30%
20%
10%
0%
Soft Tissue Fractures Other

Physio Patients
300
250
200
150
100
50
0
Patient Type
C/Spine T/Sp L/Sp Lower Limb Upper Limb Other

Clinical Role
• 626 occasions of
service.
• 64% patients primary
contact
• 48% patients managed
by a student under
supervision.

Students
• Physio students gain experience treating
conditions in a acute form.
• Physio students gain experience working in the
ED model of care.
• Physio students gain
experience in fracture
management.

Students
• All students have reported being satisfied or very
satisfied overall with the placement.
• All student reported now considering working in
a rural area upon graduation.
• Students reported difficulty with travelling costs
and being away from sports & work during
placement

Students
• Medical students taught clinical reasoning for
musculoskeletal injuries
• Medical students taught taping, plastering and
exercise prescription.
• Medical and physio students often work together
interprofessionally.

Future Directions
• Assess patient satisfaction and waiting times.
• Further education for medical & nursing staff in ED.
• Funding application for IPL unit in ED.

Future Directions
• RCT on ankle sprain treatment.
• Expand role with med, nursing and radiography
students
• Plan for physio student to spend a whole year in
Tamworth which would include an ED placement

Implications
• Allied health practitioners can make significant
contribution to patient care and the overall
functioning of an emergency department.
• In order to satisfy the demands for student
placements innovative methods of clinical
placement delivery must be utilised.

References
Anaf, S. and L. A. Sheppard (2007). "Describing Physiotherapy Interventions in an Emergency
Department Setting: An Observational Pilot Study." Accident and Emergency Nursing 15: 34-39.
Anaf, S. and L. A. Sheppard (2007). "Physiotherapy as a Clinical Service in Emergency
Departments: a Narrative Review." Physiotherapy 93(4): 243-252.
Ball, S. T. E., K. Walton, et al. (2007). "Do Emergency Department Physiotherapy Practitioner's,
Emergency Nurse Practitioners and Doctors Investigate, Treat and refer Patients with Closed
Musculoskeletal Injuries Differently." Emergency Medicine Journal 24: 185-188.
Bethel, J. (2005). "The Role of the Physiotherapist Practitioner in Emergency Departments: A
Critical Appraisal." Emergency Nurse 13(2): 529-549.
Kempson, S. (1996). "Physiotherapy in an Accident and Emergency Department." Accident and
Emergency Nursing 4(4): 198-202.
Lau, P., D. Chow, et al. (2008). "Early Physiotherapy Intervention in an Accident and Emergency
Department Reduces Pain and Improves Satisfaction for Patients with Acute Low Back Pain: A
Randomised Trial." Australian Journal of Physiotherapy 54(4): 243-9.
Morris, C. and S. J. Hawes (1996). "The Value of Accident and Emergency Based Physiotherapy
Services." Journal of Accident and Emergency Medicine 13: 111-113.