Physical Therapy in the ER Setting

[LegzRN]

Hello all,

My girlfriend is a doctorate of physical therapy student and everyone in her class had to pick a physical therapy setting, write a paper about it and then present their findings. She picked the emergency department setting. I've worked ED for around 2 years now, both a community ED and now currently a level II trauma center, and I don't ever recall seeing a physical therapist once, except for a time when a PT outpatient had a vasovagal response and the PT brought her down. Have any of you ever worked with a physical therapist or PTA in the ED setting?

Thanks in advance!

[JustBeachyNurse, LPN]

The only time I ever saw PT in the ER was for the inservice for staff on proper lifting & body mechanics and to educate the ER techs how to properly fit crutches for patients. I had never seen PT routinely in the ER, in fact for the education sessions staff had to go to the PT dept.

[GreyGull]

Excellent idea! Phyical Therapy is one of the leaders in forward thinking for health care alternatives. I believe PT has made the ED part of their vision statement and are going for that goal. Kudos to your friend for also sharing that view. Your friend could contact the PT department at Northern AZ University and some of the AZ hospitals. Flagstaff Medical Center and Carondelet St. Joseph's Hospital may already be utilizing an ED based PT.

[steelcityrn, RN]

I review physical therapy notes on a daily basis. It has been a real eye opener.

[bill4745, RN]

We sometimes have a PT consult in the ED to see if someone can walk safely enough for discharge.

[OTconsideringBSN]

As an occupational therapist, I know that I have gotten as physicians orders (and physical therapists usually get more) to evaluate patients in the ER for balance, ambulation, and to determine if someone can go directly home or whether inpatient/outpatient rehabilitation is recommended. It is usually a consult only in the hospital I worked in, unless the patient was later admitted to the hospital (usually not the case).

[GreyGull]

Often when a patient comes into the ED with a complaint of pain, either chronic or acute, they are given a script for pain meds and told to consult their PCP about getting physical therapy. Rarely are they educated about their pain or what physical therapy is. This lack of understanding then leads the patient to later return to the ED for more pain meds and another thread on this forum griping about ED abuse.

Physical Therapists can add an indepth dimension for educating the patient as well as introducing them to what physical therapy can do. PTs could provide an alternative to prescribing narcotics to every patient complaining of pain. They can spend more time explaining proper ambulation and assistive device techniques which benefits safety and pain relief or the element of causing more pain. Symptoms of vertigo and wound care are two other areas where the PT stands out. PTs pick up on details that ED physicians and RNs are not trained for nor do they have the time.

Studies have already shown reductions in ED visits and hospital stays when certified Asthma and COPD educators (can be RNs or RRTs) are used at discharge from either the hospital, the ED or clinics. I don't see why it could apply to PT as well.

Maybe it is time to stop tossing more pills (or inhalers) at the patient and do some education combined with treatment that could make a difference.

[Emergency RN]

Er... Have people forgotten? We already have patients stacked three deep into the hallways nearly every day. So we now have to wait additionally for a PT consult with every patient? Forgive me, let's take care of a whole multitude of other ED problems first. ED PT sounds great but is totally pie in the sky unrealistic. Physical Therapy is something that is a long term focus. Within the context of the short duration contact of a busy ED, it may not be the most appropriate devotion of time and resources. This may be a great idea in a small town, low patient volume ED. But in the high patient traffic areas, will run into many logistical hurdles.

Upon discharge in our ED, all our patients are routinely given discharge instructions which, if followed properly, includes directions on PT services (as an adjunct usually to Orthopedic follow up). Many of the things that other respondents talked about (in depth patient teaching, ambulation trials) sounds more appropriate for discharge center staff who have the time and focus to do so. In the ED, we've already moved on to begin care for the next patient; the previous patient needs to get off the gurney and leave now in order to make room for someone else that is bleeding on my floor.

[GreyGull]

So we now have to wait additionally for a PT consult with every patient?

Do all of your patients need a PT consult? Not every patient needs a PT consult and PT's resources should not be wasted either.

However, if it prevents repeat visits or an actual Physical Therapist explains what the patient can expect rather than just being handed a piece of paper, the patient might be more likely to follow through with a referral. The information provided by a PT can also give the physician a better insight on appropriate treatment and referral.

Those who constantly complain about being over worked and over crowded EDs are also the ones who criticize any efforts by other services to alleviate some of the problem and or to at least get the appropriate information to patients that might actually utilize it. If you don't want to explore other options to find solutions or provide more effective care, you essentially become part of the problem.

Patients also know you want them out of the ED quickly and that it is easier to just push some pills and hand over a script. Thus, you can expect the repeaters and the system has now created its own mess by supporting this cycle of behavior.

[Larry77, RN]

OT would make more sense to me than PT...

[GreyGull]

OT would make more sense to me than PT...

Any particular reason why?

PT will usually determine by assessment what therapies and treatment the patient will require before OT can see the patient. We don't see OT in the ICUs or acute floors but we see plenty of PT. They are also included in all of the ICU rounds.

[LegzRN]

the previous patient needs to get off the gurney and leave now in order to make room for someone else that is bleeding on my floor.

Agreed. Especially when the proverbial sh!t hits the fan and traumas are rolling in three deep.