Evaluation of performance quality of an advanced scope physiotherapy role in a hospital emergency department

Abstract

BackgroundPhysiotherapists working in advanced and extended scope roles internationally make a difference to workflow, performance targets, and patient satisfaction in areas traditionally served by medicine and nursing.AimTo assess the impact of an advanced scope of practice physiotherapist (ASoP-PT) service in a large Australian hospital emergency department (ED) by measuring national service and triage category indicators, patient and staff satisfaction.MethodsConsecutive patients consulting the ASoP-PT were recruited over 53 weeks following service inception. Descriptions of ASoP-PT activities and patients were collected. Performance was assessed against national ED indicators for length of stay and wait. Patient and staff perspectives were assessed independently by semi-structured interviews. The physiotherapist was formally trained to extended scope of practice including competency in medicines, prescription and application. The legislation prevented him from applying these skills, therefore he worked in an ASoP-PT role in ED.ResultsThe ASoP-PT treated on average, 72 patients per month in ten shifts per fortnight, consulting patients aged from 1 to 88 years. Patients largely presented with musculoskeletal problems in triage Categories 4 and 5. There were shorter length of wait and length of stay, when the ASoP-PT was on shift. However overall compliance with national performance targets was similar with and without the ASoP-PT. Staff and patient satisfaction was high, particularly valuing the ASoP-PT’s expertise in musculoskeletal injuries.ConclusionThe ASoP-PT performed at least as well as other ED health care providers in meeting national triage targets. Had the legislation permitted his independent prescription of medicines, the ASoP-PT could have worked in an extended scope role, and his performance in meeting targets may have been better.

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

“…It was deemed helpful to have a social worker with the time and skills to support patients and families in stressful situations in hospital; this strength based approach is in keeping with the principles of Whänau Ora, a Ministry of Health initiative to place families at the centre of service delivery (MOH 2012) This project had similar findings to other studies (Lau et al 2008, McLellan et al 2005, Morris et al 2015 in terms of positive feedback from patients, staff and stakeholders, and supports the benefit of a team approach in addressing the needs of complex presentations (Moss et al 2002). Where this study differs is in viewing both social work and physiotherapy as part of an allied health team, and also in their individual roles, providing data to support both professions being embedded within the ED service.…”

“…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.…”

“…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.…”

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

“…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%).…”

“…3 The first description of physiotherapists acting in an extended scope of practice role was from the UK, in the mid-1990s. 7 ED physiotherapists in the UK can now prescribe after completing a Health and Care Professions Council (HCPC) prescribing programme. 7 ED physiotherapists in the UK can now prescribe after completing a Health and Care Professions Council (HCPC) prescribing programme.…”