Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in an adult emergency department

Abstract

Objectives: To evaluate the effect of introducing an extended scope physiotherapy (ESP) service on patient satisfaction, and to measure the functional outcome of patients with soft tissue injuries attending an adult emergency department (ED), comparing management by ESPs, emergency nurse practitioners (ENPs), and all grades of ED doctor. Methods: The ESP service operated on four days out of every seven in a week in an urban adult ED. A satisfaction questionnaire was sent to all patients with a peripheral soft tissue injury and fractures (not related to the ankle) within one week of attending the ED. Patients with a unilateral soft tissue ankle injury were sent the acute Short Form 36 (SF-36) functional outcome questionnaire, with additional visual analogue scales for pain, at 4 and 16 weeks after their ED attendance. Waiting times and time spent with individual practitioners was also measured. Results: The ESP service achieved patient satisfaction that was superior to either ENPs or doctors. Overall 55% of patients seen by the ESP service strongly agreed that they were satisfied with the treatment they received, compared with 39% for ENPs and 36% for doctors (p = 0.048). Assessment of long-term outcome from ankle injury was undermined by poor questionnaire return rates. There was a trend towards improved outcomes at four weeks in those patients treated by an ESP, but this did not achieve statistical significance. Conclusion: Adding an ESP service to the interdisciplinary team achieves higher levels of patient satisfaction than for either doctors or ENPs. Further outcomes research, conducted in a wider range of emergency departments and integrated with an economic analysis, is recommended.

Physiotherapy extended scope of practice – who is doing what and why?

“…(25)(26)(27) Only one of these studies compared treatment provided by an ESP and other professionals and this study was the first to describe an ESP service in an emergency department. (26) It was shown that 55% of patients were independently managed by the ESP and a follow-up suggested higher patient satisfaction with the ESP service.…”

The Physical Therapist as a Musculoskeletal Specialist in the Emergency Department

“…Another study reported higher satisfaction ratings when patients in the ED were seen by a physiotherapist. 56 The veterans' healthcare system in Salt Lake City reported that their program reduced the Investigations describing the relationship between patient recovery and this approach to care are notably lacking. One study using a randomized design, however, did analyze patient outcomes associated with ED-based physical therapy.…”

Can physiotherapists contribute to care in the emergency department?

“…Patient satisfaction with their management by EDPs has been reported as higher than those managed in the traditional model for musculoskeletal injuries 8,12 and for mechanical lower back pain. 11 Interestingly, however, one study noted a significantly greater time period for return to usual activity for patients with soft tissue injuries managed by EDPs, 12 so it can be seen that the clinical effectiveness of physiotherapy in ED requires attention and deliberation in some contexts.…”

“…8 Ensuring that patients managed by physiotherapists fall within the scope of practice of the profession is a significant responsibility for physiotherapists working in a primary contact capacity, in both the context of emergency or in a private community clinic. Awareness of which cases can be safely managed by a physiotherapist is important for EDPs, and to ensure patient safety from a service delivery perspective, clear guidelines should exist for appropriate selection of patients by EDPs, as well as the transferral of care to an ED medical officer should a patient's requirements extend beyond the scope of the physiotherapy profession.…”