PHYSIOTHERAPY IN THE EMERGENCY DEPARTMENT

Physiotherapists first extended their roles to work in emergency departments (ED) in the mid–1990s. Introducing a new profession into a clinical setting with an established organisational structure like the ED is complex. As the proportion of EDs that have dedicated physiotherapists continues to rise, it is worth considering factors that might facilitate the role of physiotherapists who are already in this environment, or who are planning to move into ED work. Lead author Giovanni Ferreira discusses the recent systematic review that seeks to identify these factors.

What was the stated aim of your review? 

Our aim was to synthesise ED staff and patients’ perceptions on physiotherapists working in emergency departments.

What sort of studies did you include in the review? 

We included qualitative studies of any design (eg, phenomenological, grounded theory, ethnography) written in English and published in peer-reviewed journals.

How many studies were you able to include in the review?

Our search identified eight studies.

Did these studies mainly interview staff or patients, or was there plenty of data from both groups?

From the eight studies included in our review, five studies explored perceptions of 138 patients, and four studies explored the perceptions of 122 ED staff members. It is difficult to say whether the number of interviewed people was large enough for patients and staff because most studies did not clearly state if they achieved saturation of data. That means some additional perceptions may have been missed. 

How did they view the role of the ED physiotherapist?

Patients and members of the ED staff viewed physiotherapists as experts in managing musculoskeletal conditions. They suggested that having physiotherapists in the ED enabled patients with musculoskeletal conditions to receive treatment earlier, rather than just being referred back to their general practitioners.

According to both patients and staff members, movement and exercise were considered important means to regain function. Movement assessment was also considered an important aspect of care of the elderly. Interestingly, some patients provided contrasting views on the role of exercise therapy in the ED. Some patients perceived exercise to be painful, difficult to perform and unnecessary in the ED context. Our review highlighted that the fact that exercises may not make sense for some patients must be taken into account when prescribing exercises for patients in that setting.

Physiotherapists were considered to be efficient by both patients and the staff. Having physiotherapists in the ED helped ease the pressure on those physicians and nurses, allowing them to manage patients with more serious conditions and improving general patient flow.  

What was seen as positive about having a physiotherapist in the ED?

The abilities of physiotherapists to be good team workers, and to have good interpersonal communication skills were highly valued. Physiotherapists were perceived to be capable of working in a multidisciplinary setting and seeing patients in a timely manner. Patients perceived a number of interpersonal communication skills that positively contributed to the role of physiotherapists in the ED. Being sympathetic, encouraging, friendly and supportive were qualities that facilitated physiotherapists to educate patients about their condition and prognosis.

Was anything seen as negative about having a physiotherapist in the ED?

Our review identified three main concerns about having physiotherapists working in EDs. Some patients and staff mentioned that they were unaware of what type of contribution physiotherapists could make to the ED environment, demonstrating a lack of awareness on the role of physiotherapists in that setting. In some studies, staff members were concerned about the restricted availability of physiotherapy services. That concern appeared as a sub-theme in studies in which physiotherapists worked during business hours. Staff members of EDs where physiotherapists had secondary contact roles demonstrated concerns in relation to the additional time patients spent in treatment.

Did the qualitative findings suggest many things that physiotherapists could do to facilitate their role in the ED? 

Our findings suggest that developing skills in management of musculoskeletal conditions and patient education could facilitate the role in the ED. Our findings also suggest the importance of organisational aspects for physiotherapists to be successful in that position. Given the relative novelty of this role, good communication with co-workers and patients is fundamental for the understanding of the role. Importantly,

acceptance of physiotherapists by the staff was noted by our study to be a gradual process, which occurred after physiotherapists had proven to have sufficient expertise to undertake the role, and after they had worked collaboratively with the staff in the ED.

What future pathways for research in this area did the review identify?

Our findings suggest that future studies should clarify how work organisational factors (eg, staffing characteristics, physical environment) and clinical features (eg, patient profile) may facilitate, or impose, barriers to the effective implementation of physiotherapists in EDs. We suggest future qualitative research in this area to be conducted alongside randomised trials testing the performance of this model of care that includes physiotherapists in EDs. That approach will provide a more in-depth understanding of the process underlying the success or failure of this model of care. 

Giovanni Ferreira is a physiotherapist with a keen interest in evidence-based practice. His areas of interest are back, shoulder and neuropathic pain as well as the physiological, behavioural and cognitive aspects of pain processing.