Management of patients brought in by ambulance to the emergency department: role of the Advanced Musculoskeletal Physiotherapist

Abstract

Objective The aim of the present study was to evaluate the role of the Advanced Musculoskeletal Physiotherapist (AMP) in managing patients brought in by ambulance to the emergency department (ED). Methods This study was a dual-centre observational study. Patients brought in by ambulance to two Melbourne hospitals over a 12-month period and seen by an AMP were compared with a matched group seen by other ED staff. Primary outcome measures were wait time and length of stay (LOS) in the ED. Results Data from 1441 patients within the Australasian Triage Scale (ATS) Categories 3-5 with musculoskeletal complaints were included in the analysis. Subgroup analysis of 825 patients aged ≤65 years demonstrated that for Category 4 (semi-urgent) patients, the median wait time to see the AMP was 9.5min (interquartile range (IQR) 3.25-18.00min) compared with 25min (IQR 10.00-56.00min) to see other ED staff (P ≤ 0.05). LOS analysis was undertaken on patients discharged home and demonstrated that there was a 1.20 greater probability (95% confidence interval 1.07-1.35) that ATS Category 4 patients managed by the AMP were discharged within the 4-hour public hospital target compared with patients managed by other ED staff: 87.04% (94/108) of patients managed by the AMPs met this standard compared with 72.35% (123/170) of patients managed by other ED staff (P=0.002). Conclusions Patients aged ≤65 years with musculoskeletal complaints brought in by ambulance to the ED and triaged to ATS Category 4 are likely to wait less time to be seen and are discharged home more quickly when managed by an AMP. This study has added to the evidence that AMPs improve patient flow in the ED, freeing up time for other ED staff to see higher-acuity, more complex patients. What is known about the topic? There is a growing body of evidence establishing that AMPs improve the flow of patients presenting with musculoskeletal conditions to the ED through reduced wait times and LOS and, at the same time, providing good-quality care and enhanced patient satisfaction. What does this paper add? Within their primary contact capacity, AMPs also manage patients who are brought in by ambulance presenting with musculoskeletal conditions. To the authors' knowledge, there is currently no available literature documenting the performance of AMPs in the management of this cohort of patients. What are the implications for practitioners? This study has added to the body of evidence that AMPs improve patient flow in the ED and illustrates that AMPs, by seeing patients brought in by ambulance, are able to have a positive impact on the pressures increasingly facing the Victorian Ambulance Service and emergency hospital care.

Advanced musculoskeletal physiotherapy: Barriers and enablers to multi‐site implementation

“…The AMP service model of care has been implemented across a broad range of specialities in public hospitals, with emerging evidence of improved cost efficiency (Comans, Raymer, O'Leary, Smith, & Scuffham, ; PwC, ). Positive effectiveness outcomes included improving access through a reduction in waiting times and improved patient flow (Bird, Thompson, & Williams, ; Razmjou et al, ; Kinsella et al, ; Samsson & Larsson, ; Thompson, Yoward, & Dawson, ), and high levels of patient satisfaction. AMP services are a safe model of care (Morris, Vine, & Grimmer, ; PwC, ; Sutton, Govier, Prince, & Morphett, ).…”

Review article: A scoping review of physiotherapists in the adult emergency department

“…7,8,20,21,[23][24][25][26][27][30][31][32][33][34][35]37,39,40 The most commonly reported task was imaging prescription (nine out of 17 studies, 52%). 7,8,20,21,[23][24][25][26][27][30][31][32][33][34][35]37,39,40 The most commonly reported task was imaging prescription (nine out of 17 studies, 52%).…”

“…Of the 27 studies, there were five randomised controlled trials (RCTs) [20][21][22][23][24] (n = 1434), 12 prospective observational studies [6][7][8][25][26][27][28][29][30][31][32][33] (n = 153 767), six retrospective studies [34][35][36][37][38][39] (n = 9968), two survey studies 9,40 (n = 61), one case report 41 (n = 3) and one qualitative study 42 (n = 11). ED physiotherapists acted in primary contact roles in 18 studies (66%), 7,8,20,21,[23][24][25][26][27][30][31][32][33][34][35]37,39,40 and in secondary contact roles in seven studies (26%). 6,9,22,28,38,41,…”

“…Data on the roles and tasks performed by ED physiotherapists were available for 18 studies (66%). 7,8,20,21,[23][24][25][26][27][30][31][32][33][34][35]37,39,40 The most commonly reported task was imaging prescription (nine out of 17 studies, 52%). Review of medications (e.g.…”

“…Twenty-two of the 27 studies (81%) provided information relative to the profile of patients usually seen by ED physiotherapists. [7][8][9][20][21][22][23][24][25][26][27][28][29][30][32][33][34][35]37,38,41,42 In all studies, ED physiotherapists managed patients with musculoskeletal conditions. Orthopaedic trauma, including falls and simple closed fractures, was the second most common condition seen.…”