Implementation and performance evaluation of an emergency department primary practitioner physiotherapy service for patients with musculoskeletal conditions

Gill, Stephen D.; Stella, Julian

doi:10.1111/1742-6723.12134

Cited by 33 publications

(32 citation statements)

References 14 publications

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“…7,8,20,21,[23][24][25][26][27][30][31][32][33][34][35]37,39,40 The most commonly reported task was imaging prescription (nine out of 17 studies, 52%). 7,8,20,21,[23][24][25][26][27][30][31][32][33][34][35]37,39,40 The most commonly reported task was imaging prescription (nine out of 17 studies, 52%).…”

Section: Roles and Tasks Of Ed Physiotherapistsmentioning

confidence: 99%

Review article: A scoping review of physiotherapists in the adult emergency department

Ferreira

Traeger

Maher

2018

Emerg Medicine Australasia

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To provide an overview of the literature that considers physiotherapists working in the ED in relation to their roles, training levels, patient profile, safety, effectiveness, efficiency, cost-effectiveness and the provision of low-value care. We performed a scoping review of the literature. Four databases (PubMed, EMBASE, CINAHL and Cochrane CENTRAL) were searched from their inception to December 2016 and we updated searches on PubMed in September 2017. Two reviewers independently screened studies for eligibility. We performed a narrative synthesis of quantitative data. We included 27 studies: five randomised controlled trials (n = 1434), 12 prospective observational studies (n = 153 767), six retrospective studies (n = 9968), two survey studies (n = 61), one case report (n = 3) and one qualitative study (n = 11). Physiotherapists primarily managed patients with low urgency musculoskeletal conditions. Physiotherapists appeared to have similar clinical effectiveness and costs compared to other health providers (four randomised controlled trials). Physiotherapists were associated with increased efficiency (eight observational studies) and reduced low-value care (one observational study). Three observational studies reported very low adverse event rates. However, none of the studies followed participants to measure adverse events that became apparent after the ED visit, nor did they consider unsafe discharge decisions or suboptimal follow-up care. The available evidence suggests that physiotherapists may be as effective as other health providers in managing low urgency musculoskeletal conditions in the ED. There is uncertainty about appropriate training and a lack of robust studies investigating the efficiency, safety and cost-effectiveness of this model of care.

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Section: Roles and Tasks Of Ed Physiotherapistsmentioning

confidence: 99%

Review article: A scoping review of physiotherapists in the adult emergency department

Ferreira

Traeger

Maher

2018

Emerg Medicine Australasia

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“…Triage wait times have been used in other studies (Gill and Stella 2013, McClellan et al 2005, Morris et al 2015 to prove effectiveness of primary physiotherapy service in reducing waiting times. This would have been difficult to use in our study with physiotherapists treating both primary and secondary referrals, and with other co-jointly running initiatives, such as encouraging people with minor injuries to seek treatment in the primary care sector rather than ED.…”

Section: Limitationsmentioning

confidence: 99%

“…Also, there are increasing issues in providing the care required within expected time frames. Different models of ED care (Australian and Limited studies have been undertaken in the UK (Jibuike et al 2003, McClellan et al 2005, 2010, Australia (Farrell 2014, Gill and Stella 2013, Lau et al 2008, Morris et al 2015 and New Zealand (Canterbury District Health Board 2006) on the introduction and benefits to ED of physiotherapy. These studies largely looked at the role of an ED physiotherapist in an advanced scope of practice (primary contact) role treating musculoskeletal presentations or specific injuries.…”

Section: Introductionmentioning

confidence: 99%

Embedding an allied health service in the Nelson hospital emergency department: A retrospective report of a six month pilot project

Holmes¹,

Hollebon²,

Scranney³

et al. 2016

NZJP

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Embedding allied health into the emergency department (ED) was considered the best option by a 2011 Nelson Marlborough District Health Board (NMDHB) strategic planning group exploring innovative ways to bridge the gap between primary care and the ED and thus enhance the service. A six month pilot project implemented in 2012 aimed to provide a more timely multidisciplinary approach to patient care, facilitate safe discharge and linkages into the primary care sector, reduce multiple presentations and keep within ED designated time frames. Physiotherapy and social work practitioners worked as part of an inter-disciplinary team to comprehensively assess clients' specific needs. The establishment of primary physiotherapy contact, where appropriate patients were identified directly from initial presentation, solely assessed and treated by the physiotherapist improved patient flow for lower triage presentations and made full use of staffing resources. Data collection over the first 22 weeks showed the allied health practitioners in ED had 749 new patient contacts, including 120 primary physiotherapy contacts. ED patients found the service extremely helpful. Survey responses from key stakeholders and ED staff highlighted the benefit of allied health interventions in improving safety of ED discharges, and the value of comprehensive client centred patient care. The Executive Leadership Team of the NMDHB unanimously endorsed the continuation of the allied health service in the emergency department from December 2012.

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“…Another audit of pain management in the ED also revealed that approximately two-thirds of patients with pain in the ED could not obtain pain relief when measured at discharge 11. An integrated patient care approach to improve patient satisfaction and the efficient use of healthcare resources by non-emergent patients in the ED have been explored,12 13 which implies the potential role of acupuncture in such contexts. In a systematic review, we found that current evidence is insufficient to make any recommendations concerning the use of acupuncture in the ED due to the high risk of bias and the scarcity of primary studies 13.…”

Section: Introductionmentioning

confidence: 99%

Acupuncture as analgesia for non-emergent acute non-specific neck pain, ankle sprain and primary headache in an emergency department setting: a protocol for a parallel group, randomised, controlled pilot trial

et al. 2014

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IntroductionThis study aims to assess the feasibility of acupuncture as an add-on intervention for patients with non-emergent acute musculoskeletal pain and primary headache in an emergency department (ED) setting.Methods and analysisA total of 40 patients who present to the ED and are diagnosed to have acute non-specific neck pain, ankle sprain or primary headache will be recruited by ED physicians. An intravenous or intramuscular injection of analgesics will be provided as the initial standard pain control intervention for all patients. Patients who still have moderate to severe pain after the 30 min of initial standard ED management will be considered eligible. These patients will be allocated in equal proportions to acupuncture plus standard ED management or to standard ED management alone based on computer-generated random numbers concealed in opaque, sealed, sequentially numbered envelopes. A 30 min session of acupuncture treatment with manual and/or electrical stimulation will be provided by qualified Korean medicine doctors. All patients will receive additional ED management at the ED physician's discretion and based on each patient's response to the allocated intervention. The primary outcome will be pain reduction measured at discharge from the ED by an unblinded assessor. Adverse events in both groups will be documented. Other outcomes will include the patient-reported overall improvement, disability due to neck pain (only for neck-pain patients), the treatment response rate, the use of other healthcare resources and the patients’ perceived effectiveness of the acupuncture treatment. A follow-up telephone interview will be conducted by a blinded assessor 72±12 h after ED discharge.Ethics and disseminationWritten informed consent will be obtained from all participants. The study has been approved by the Institutional Review Boards (IRBs). The results of this study will guide a full-scale randomised trial of acupuncture in an ED context.Trial registration numberClinicalTrials.gov: NCT02013908.

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Implementation and performance evaluation of an emergency department primary practitioner physiotherapy service for patients with musculoskeletal conditions

Cited by 33 publications

References 14 publications

Review article: A scoping review of physiotherapists in the adult emergency department

Review article: A scoping review of physiotherapists in the adult emergency department

Embedding an allied health service in the Nelson hospital emergency department: A retrospective report of a six month pilot project

Acupuncture as analgesia for non-emergent acute non-specific neck pain, ankle sprain and primary headache in an emergency department setting: a protocol for a parallel group, randomised, controlled pilot trial

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