Can physiotherapists contribute to care in the emergency department?

Abstract

Throughout the history of healthcare practice, controversy has often surrounded instances of non-medical clinicians, such as allied health practitioners, undertaking roles traditionally performed by doctors. While this blurring of professional boundaries may occur in response to a need to enhance the efficiency of health service delivery, concerns invariably arise regarding the quality of care delivered by non-medical clinicians and the potential negative implications for patient safety.1 In recent years, physiotherapists have begun to practice in Australia’s emergency departments (EDs) as autonomous, primary contact clinicians responsible for many duties traditionally solely within the domain of the medical profession. Some controversy does exist around this development, and as such, gives rise to the following questions: Do physiotherapists deliver quality care in the ED? Has the introduction of physiotherapists to ED improved service delivery as intended? Decreasing waiting times and improving efficiency of patient management in EDs is a significant goal of modern healthcare delivery. Patients presenting with mechanical musculoskeletal pathologies can experience long waiting times in busy departments, as medical staff must prioritise higher triage category patients with more urgent medical issues. The use of suitably trained and experienced physiotherapists as primary contact clinicians has been implemented in EDs in the United Kingdom, Australia, and the United States, in an attempt to reduce waiting times for such patients, and to reduce clinical loads placed upon medical staff. Emergency department physiotherapists (EDPs) are responsible for the management of patients with semiurgent and non-urgent (Australian triage categories 4 and 5) musculoskeletal complaints. Their role includes undertaking patient interviews and examinations, ordering investigations such as X-rays, making a diagnosis, implementing suitable interventions, referring for ongoing management, and arranging patient discharge.2 EDPs may also contribute to the care of patients with acute respiratory conditions (e.g. secretion clearance interventions) or facilitate the discharge of patients from ED into the community to reduce preventable hospital admissions. Such clinicians practice autonomous to medical staff in the management of presentations within their scope of practice, such as ankle or knee sprains and mechanical back pain, in a similar capacity as a physiotherapist working in a private clinic. EDPs may also practice in collaboration with medical staff in the management of simple limb fractures, or as a secondary practitioner providing physiotherapy input to respiratory conditions or an opinion regarding musculoskeletal injuries. In Australia, as this role is outside the traditional duties of physiotherapists, this is termed “advanced practice”.3