Physiotherapy students in rural emergency departments: A NEAT place to learn

Abstract

This paper questions if physiotherapy students in a rural emergency department (ED) gain exposure to a range of conditions and explores their impact on patient flow.ED is an emerging setting for physiotherapy 1 and requires specific skills. Research suggests medical students in ED may increase patient length of stay and that the busy nature of ED may hinder quality clinical learning. 2 However patients attend ED for issues commonly managed by physiotherapists such as pain and reduced mobility, and these are some key areas for physiotherapy student learning. 3 Since 2009, the University of Newcastle Department of Rural Health funded physiotherapy positions in two rural EDs in New South Wales. These roles provide a physiotherapy service in the EDs while supervising students on placement. Physiotherapy students' benefit from exposure to a range of patients and rural EDs tend to have a broader case-mix than metropolitan EDs. 4 Participants, methods and resultsThird and fourth year physiotherapy students from the University of Newcastle who undertook an ED placement at Tamworth Rural Referral Hospital or Manning Rural Referral Hospital (both Modified Monash Model Category (MMM) 3) 5 were included in the study. Patient demographic, diagnostic and treatment data were recorded for each occasion of service from January 2013 to May 2015. Diagnostic data were classified into either hard tissue (fracture), soft tissue (sprains or strains) or other (such as a mobility assessment). This was further classified into the body part affected for example the shoulder or ankle.Concurrently, National Emergency Access Target (NEAT) times for 20 randomly selected days in 2013 when there were physiotherapy student's working in the EDs were compared to the closest same days of the week when there was a physiotherapist only. For each of the days when students were present in the ED there were two physiotherapy students and one physiotherapist. NEAT times measure the time patients spend in ED from triage to discharge. This project was approved by Hunter New England Human Research Ethics Committee (AU2001504-04).Since 2009, 123 third and fourth year physiotherapy students have completed a placement in the rural EDs.Physiotherapy students' case-mix involved a variety of musculoskeletal and orthopaedic conditions including 36% hard tissue injuries, 60% soft tissue injuries and 4% other injuries. Patients were aged from 1 year to over 100 years old and resided in a variety of MMM categories with 90% of people residing in MMM3, 4% from MMM5, 2% from MMM1 and less than 1% from the other categories. The students managed a wide variety of body areas (Fig. 1) and used a range of treatment techniques including exercise prescription, plastering and manual therapy.Comparison of NEAT times showed no significant difference between the NEAT scores when there were physiotherapy students to when there were not (P = 0.71) and no significant difference for any individual triage category. Therefore physiotherapy students in ED did not add to patient length of ...

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

“…Of the 27 studies, there were five randomised controlled trials (RCTs) [20][21][22][23][24] (n = 1434), 12 prospective observational studies [6][7][8][25][26][27][28][29][30][31][32][33] (n = 153 767), six retrospective studies [34][35][36][37][38][39] (n = 9968), two survey studies 9,40 (n = 61), one case report 41 (n = 3) and one qualitative study 42 (n = 11). ED physiotherapists acted in primary contact roles in 18 studies (66%), 7,8,20,21,[23][24][25][26][27][30][31][32][33][34][35]37,39,40 and in secondary contact roles in seven studies (26%).…”

“…Twenty-two of the 27 studies (81%) provided information relative to the profile of patients usually seen by ED physiotherapists. [7][8][9][20][21][22][23][24][25][26][27][28][29][30][32][33][34][35]37,38,41,42 In all studies, ED physiotherapists managed patients with musculoskeletal conditions. Orthopaedic trauma, including falls and simple closed fractures, was the second most common condition seen.…”