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FOTO Rehab Outcomes Blog

Physiotherapists Managing Patients with Musculoskeletal Complaints in Emergency Department

Physiotherapists managing patients with musculoskeletal conditions arriving by ambulance immediately had me thinking, "no way."

Here's another study done in Australia. Now the key for sucessful interpretation and implementation of physiotherapists in the emergency department... triage. Physiotherapists were not involved with every patient. Physiotherapists were involved in the care of patients in Categories 3-5. That makes sense and offsets my gut response. Australia has Advanced Musculoskeletal Physiotherapists practicing in their emergency departments.

Hospital systems may begin to shift emergency department personnel so that the skill level and knowledge level required to care for someone admitted into an emergency department matches the care required. Here in the States, the role of the physical therapist may be dependent upon state practice acts and scope of care.

Below you will find a quick view of the abstract. 


Management of patients brought in by ambulance to the emergency department: role of the Advanced Musculoskeletal Physiotherapist.


Objective The aim of the present study was to evaluate the role of the Advanced Musculoskeletal Physiotherapist (AMP) in managing patients brought in by ambulance to the emergency department (ED).

Methods This study was a dual-centre observational study. Patients brought in by ambulance to two Melbourne hospitals over a 12-month period and seen by an AMP were compared with a matched group seen by other ED staff. Primary outcome measures were wait time and length of stay (LOS) in the ED.

Results Data from 1441 patients within the Australasian Triage Scale (ATS) Categories 3-5 with musculoskeletal complaints were included in the analysis. Subgroup analysis of 825 patients aged ≤65 years demonstrated that for Category 4 (semi-urgent) patients, the median wait time to see the AMP was 9.5min (interquartile range (IQR) 3.25-18.00min) compared with 25min (IQR 10.00-56.00min) to see other ED staff (P ≤ 0.05). LOS analysis was undertaken on patients discharged home and demonstrated that there was a 1.20 greater probability (95% confidence interval 1.07-1.35) that ATS Category 4 patients managed by the AMP were discharged within the 4-hour public hospital target compared with patients managed by other ED staff: 87.04% (94/108) of patients managed by the AMPs met this standard compared with 72.35% (123/170) of patients managed by other ED staff (P=0.002).

Conclusions Patients aged ≤65 years with musculoskeletal complaints brought in by ambulance to the ED and triaged to ATS Category 4 are likely to wait less time to be seen and are discharged home more quickly when managed by an AMP. This study has added to the evidence that AMPs improve patient flow in the ED, freeing up time for other ED staff to see higher-acuity, more complex patients.

What is known about the topic? There is a growing body of evidence establishing that AMPs improve the flow of patients presenting with musculoskeletal conditions to the ED through reduced wait times and LOS and, at the same time, providing good-quality care and enhanced patient satisfaction.

What does this paper add? Within their primary contact capacity, AMPs also manage patients who are brought in by ambulance presenting with musculoskeletal conditions. To the authors' knowledge, there is currently no available literature documenting the performance of AMPs in the management of this cohort of patients.

What are the implications for practitioners? This study has added to the body of evidence that AMPs improve patient flow in the ED and illustrates that AMPs, by seeing patients brought in by ambulance, are able to have a positive impact on the pressures increasingly facing the Victorian Ambulance Service and emergency hospital care.

2017 May 9. doi: 10.1071/AH16094. [Epub ahead of print]