Eli's Rehab Report

New APTA toolkit helps practitioners navigate this growing trend.

Hospitals around the country are tuning in to a growing trend of having physical therapists in their emergency departments.

According to the American Physical Therapy Association, benefits of having PT in the ED include increased patient satisfaction, decreased cost of unnecessary care, better treatment and service options, improved patient outcomes, and increased productivity within the ED.

"Physical therapy has had a presence in larger community ERs for some time," notes Ron Barbato, PT, administrative director of rehabilitation services for Ephraim McDowell Health in Danville, KY. "The role of the physical therapy, however, is changing in the ER from supportive -- gait training, for example -- to more of a hands-on treatment approach, such as evaluation and treatment of conditions that present with pain or dysfunction."

How it works: "ED PTs primarily see patients with conditions affecting the musculoskeletal system," says Michael Lebec, PT, PhD, associate professor of physical therapy at Northern Arizona University, who helped develop the first fulltime PT program in an ED in 1998. His program used the following model: the patient is admitted to the ED, and the emergency physician sees the patient and determines if PT would help. A PT, then, evaluates the patient, gives clinical intervention, educates the patient on self-care, and discuses follow-up recommendations with the emergency physician.

"Many times this [PT] intervention negates the need for specialist follow up," Barbato says. "For example, chest pain, once cleared as a cardiac cause, is many times linked to rib or shoulder dysfunction" -- which a PT can manage.

PTs can also provide safety assessments to determine the best discharge destination, be it home, skilled nursing, or hospital admission, Lebec tells Eli.

Consider These Logistics

1) Employment model. While it's possible for contract therapists to work in the ED setting, hospital employees may be the ideal setup, "due to the need for strong relationships between hospital administration, ED staff, and the PT department," Lebec says.

2) Training. Be sure your ED PTs have a strong suit in treating musculoskeletal problems. "Specialized skills such as management of vestibular patients and wound care are also valuable to have," Lebec notes.

3) Reimbursement. Most ED programs with PT have proved sustainable, but because many patients treated in the ED do not have insurance and EDs are legally obligated to provide services for them, make sure you have enough patient volume to cover costs, Lebec recommends.

4) Getting the go-ahead. "Many traditional ED staff do not fully understand the role PTs play in this setting, making an ED PT program development difficult to 'sell' to program administrators," Lebec notes. However, you may get their attention with the prospect of cutting costs. "We have anecdotal evidence that outlines how PT management has saved the patient time and money by aiding in diagnosis or providing treatment, which allowed them to go home instead of being admitted to the hospital," Lebec says.

Extra help: On Jan. 9, the American Physical Therapy Association released a toolkit on how to establish PT services in the ED. Complete with detailed case studies, the tool describes recent trends in ED care, discusses patient conditions PTs will encounter, and outlines the necessary skills and knowledge that's necessary for a PT to be successful in an ED environment.