Physiotherapists in ED: A city wide service supporting board performance, government targets, professional growth and most importantly patient care

Purpose

The Scottish Government's Emergency Access Standard aims for 98% (95% target) of all patients to be admitted, transferred or discharged within 4 hours from arrival at Emergency departments. This is supported by a National Improvement Programme following collaborative methodology to dynamically spread best practice and learning nationally. Work to date in this area has focussed less on how MSK physiotherapists can support this and support optimum benefit across Scotland.

Growing numbers of patients with acute MSK problems attend the Emergency Department (ED). These minor conditions are often left waiting and are more likely to breach the 4 hour target, as nurses and medics focus on sicker patients. But physiotherapists are touted as being experts in MSK? So why not test this and see not only how it affects the 4 hour access standard but the patient journey?

Across the 3 sites
(28/01/19 to 07/04/19) the EDPP managed 1045 patients.
Resulting in 97.1%
(1015) were seen within 4 hours
Median time spent with EDPP
= 35 minutes
91.7%
(958) were discharged   
2%
(21) admitted
6.3%
(66) identified as non MSK

Approach

Funding from Scottish Government 6 Essential Actions for unscheduled care winter plan was provided by NHS Greater Glasgow & Clyde Board to test 3 full time emergency department physiotherapist practitioner posts (EDPP) in three of the Boards EDs.

The EDPP´s main role was to support the minor Flow 1 performance and by providing specialist physiotherapy input to MSK patients, take automomous control of the patient from assessmement, including ability to request x-rays, through to discharge with an empahsis of safety and self-care for often benign but painful MSK presentations.

ED consultants and physiotherapy professional lead supported were required, however the EDPPs worked autonomously across scheduled and unscheduled care, weekdays and weekends to evaluate where they could make the biggest impact.

Outcomes

Across the 3 sites (28/01/19 to 07/04/19) the EDPP managed 1045 patients. This freed up 1045 slots for doctors and nurses to see other more medically complex patients.

Performance

•           Median time to first assessment (EDPP) = 49 minutes

•           Median time spent with EDPP = 35 minutes

•           Median time in ED = 1 hr 32 mins

•           Resulting in 97.1% (1015) were seen within 4 hours

Outcomes

•           91.7% (958) were discharged

•           6.3% (66) identified as non MSK

•           2% (21) admitted

Implications

Specialist physiotherapists undoubtably have an important role to play in ED in the management of patients with MSK problems. Data from this pilot has demonstrated that the EDPP safely managed MSK patients in a timely manner and guided most of these patients onto self care, with the right healthcare professional providing the correct advice at the correct time. This enabled medics and nurse to be free to manage more medically unwell patients, in an equally timely and appropriate manner.

This work focussed solely on supporting the 4 hour target and minor flow. It was successful. Substantive funding needs to be found to maintain these posts. However, MSK patients do not turn up in ED in a regular manner and work is required to refine the EDPP model to minimise downtime and upskill the EDPP to support other work on the periphery of ED, such as soft tissue clinics and return clinics as well as pass on expert MSK knowledge to their ED colleagues.

Funding acknowledgements

Funding was allocated from the already agreed Unscheduled Care Winter plan.

Additional notes

This work was presented at Physiotherapy UK 2019