PHYSICAL THERAPY SERVICE IN THE EMERGENCY DEPARTMENT – EVALUATION OF A PILOT STUDY IN A SWISS UNIVERSITY HOSPITAL

B.R. Winteler^1,2, F. Geese¹, B. Lehmann³, K.-U. Schmitt¹

Background: Many countries report a significant increase in emergency department (ED) visits. Among those, patients with musculoskeletal disorders account for a large proportion of non-urgent cases. This trend was also observed at the ED of Bern University Hospital, Switzerland. So far, the immediate management of these patients primarily included pharmacotherapy and orthotic treatment. Physical therapy was prescribed according to the physician’s assessment and took place in an outpatient setting (most often in a private practice), days to weeks after discharge from the ED, depending on available capacities. Since the literature reports possible benefits of musculoskeletal physical therapy delivered in the ED, we launched a pilot study to test such a service at our emergency department.

Purpose: A new service providing these emergency department patients with immediate access to physical therapy was introduced and evaluated.

Methods: In a pilot project, a physical therapy service was offered for two months in a mixed emergency department at Bern University Hospital. The service was available between 11.00h and 19.00h (weekdays) and 11.00h to 14.00h (weekends). The senior physician on duty was responsible to identify suitable patients and to refer them to the physical therapist. Multimodal physical therapy was applied. In order to examine the impact of the new service, a mixed-methods design was used. Quantitative data was gathered from the electronic patient file and from a logbook led by the physical therapists. In addition, personal interviews with involved physical therapists, doctors and nurses of the emergency department and representatives of the ED management were conducted based on a semi-structured literature-based interview guide.

Results: 79 patients (64% men, 36% women) were treated by physical therapists during the pilot study (63 days). The average age was 44.3 years. The most frequently reported complaint of the patients was back pain (47%). 16% suffered from neck pain. Physical therapists were most frequently consulted for a combination of analgesia, improvement of joint function, and mobilization (35%). Interventions included taking the medical history, performing manual tests and multimodal treatment and developing recommendations for further treatment. In the majority of patients neither medical imaging (59%) nor additional physical therapy (58%) was prescribed by the doctors. Patients rated the physical therapeutic service as very good or excellent (88%). Other staff at the ED appreciated the new service and all seven interviewees emphasized the added value for patients.

Conclusion(s): The focus of the physical therapy service on patients with primarily musculoskeletal complaints was reasonable. The evaluation showed that the physical therapeutic interventions have the potential to improve quality of care. For the profession of physical therapy an assignment in an ED may represent an opportunity for further development.

Implications: The results of the pilot study support the introduction of a regular physical therapy service in the ED of our hospital. Further steps are needed to ensure a successful implementation into the complex processes of the ED.

Funding, acknowledgements: The study was supported by internal funds of the Academic-Practice-Partnership between Bern University of Applied Sciences and Insel Gruppe.

Keywords: Emergency Service, Hospital, Physical Therapy Specialty, Musculoskeletal Diseases

Topic: Service delivery/emerging roles

Did this work require ethics approval? No

Institution: Directorate of nursing, medical-technical and medical-therapeutic areas, Insel Gruppe

Committee: Ethics Committee of the Canton of Bern (No. Req-2019-00208)

Reason: Since this work does not fall under the Swiss Human Research Law, no special approval was necessary.