In perspective: Shining a spotlight on A&E

Log-jams in A&E hit the headlines again this month. Eve Jenner explains how physios can play their part in speeding up care and cutting costs.

Rarely does a day go by without A&E services getting media exposure as they struggle to cope with rising demand and missed targets. We read about waiting times and the enormous pressure staff face. But perhaps not enough attention is paid to the skill mix in A&E teams and how they can be expanded to help patients get through the system quicker and more effectively.
A new  briefing on A&E in the physiotherapy works series seeks to address this by setting out two crucial roles for the profession. Emergency physio practitioners mostly see patients presenting with musculoskeletal (MSK) problems. They provide expert assessments, order and interpret tests, such as X-rays, manage wounds, soft-tissue injuries and fractures, and provide advice and treatment.
As the briefing shows, physios managing MSK injuries in this way have equivalent clinical outcomes and lower direct costs than doctors or emergency nurse practitioners. Physios also work in multidisciplinary therapy teams in A&E and medical admission units, bringing to bear their expertise in assessment, discharge management and arranging care after leaving hospital.
This helps to stop older people who have fallen, for example, from being admitted and avoids the clinical risks linked to hospitalisation. This is critical as people over 65 are the fastest growing group of A&E attendees and delayed discharge is said to be at the highest ever level. That truly gets to the heart of physiotherapy’s ‘offer’, especially when it comes to emergency care.
The profession’s skills in assessment, diagnosis and treatment are allied with a knowledge, understanding and vision of how the system should fit around people to get them to where they want to be, both physically and geographically. If used properly, these talents could bring huge benefits for the NHS.
About a fifth of the 18.3 million people who attend A&E each year have MSK problems. Many of them could be assessed and managed by a physiotherapist, as could many people attending with other conditions, such as chronic obstructive pulmonary disease. This would free up doctors to see more medically complex cases and reduce waiting times.
It would also cut costs in a significant way – when Salford Royal NHS Foundation Trust introduced an advanced physiotherapist role to assess, diagnose and treat people presenting with MSK injuries, the new pathway cut costs by 60 per cent or £32 for each patient. Finally, by viewing patient care in its wider context, physios working in A&E could help the NHS on its path to becoming a more responsive, person-centred system. For the physios themselves, the rewards would also be significant.
The work demands high standards and presents opportunities to learn new skills and broaden your practice. 
As with all physiotherapy works briefings, various teams at the CSP will use it to make the case for the profession to commissioners.
However, members can play their part by using it as evidence in conversations with colleagues, commissioners and colleagues to demonstrate what we can bring to this high-profile service.
To download a copy of the briefing, visit the website here.  

Eve Jenner is a CSP professional adviser

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