Physical therapy in the emergency department: A new opportunity for collaborative care

Kim, Howard; Strickland, Kyle J.; Mullen, Katie; Lebec, Michael

doi:10.1016/j.ajem.2018.05.053

Cited by 27 publications

(30 citation statements)

References 31 publications

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“…There is emerging evidence that physical therapists bring added value to ED practice, especially given that many visits are for musculoskeletal injuries and, within older adult populations, falls or ambulation concerns. 20,21…”

Section: Helping Offload Emergency Department Volume As Part Of An Inmentioning

confidence: 99%

“…Utilization of physical therapy in the ED has been associated with shorter wait times (less overcrowding in waiting areas) and lower rates of hospital admissions for acute musculoskeletal conditions-critical outcomes during the peak of viral pandemics. 20 Physical therapists also can manage other conditions, such as benign paroxysmal positional vertigo, for which ED burden is high, and follow-up may be required to avoid recurrent falls and injury.…”

Section: Helping Offload Emergency Department Volume As Part Of An Inmentioning

confidence: 99%

“…Use of physical therapists in the ED is associated with lower burden on ED physicians, which is critical given the increasing patient complexity during pandemics. 20,[22][23][24] Overburdened care planning staff, such as nurses and social workers, also can benefit from physical therapist expertise in the ED. Involving physical therapists in care transitions may help reduce avoidable ED revisits and hospital admissions related to elevated ED-related disability.…”

Section: Helping Offload Emergency Department Volume As Part Of An Inmentioning

confidence: 99%

See 2 more Smart Citations

The Essential Role of Home- and Community-Based Physical Therapists During the COVID-19 Pandemic

Falvey

Krafft²,

Kornetti³

2020

Physical Therapy

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Section: Helping Offload Emergency Department Volume As Part Of An Inmentioning

confidence: 99%

Section: Helping Offload Emergency Department Volume As Part Of An Inmentioning

confidence: 99%

Section: Helping Offload Emergency Department Volume As Part Of An Inmentioning

confidence: 99%

See 1 more Smart Citation

The Essential Role of Home- and Community-Based Physical Therapists During the COVID-19 Pandemic

Falvey

Krafft²,

Kornetti³

2020

Physical Therapy

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“…19,22 In particular, ED-based physical therapists can aid in safety evaluation and disposition or discharge planning. 18,19,23,24 In some instances, evaluation in the ED by physical therapists has been associated with decreased wait times and decreased lengths of stay. 19,21,22 The addition of physical therapists to the ED has been associated with increased patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

“…18,19,23,24 In some instances, evaluation in the ED by physical therapists has been associated with decreased wait times and decreased lengths of stay. 19,21,22 The addition of physical therapists to the ED has been associated with increased patient satisfaction. 18,19,22,27 physical therapist inclusion in the ED is also associated with high levels of satisfaction among emergency physicians and staff.…”

Section: Discussionmentioning

confidence: 99%

The utility of emergency department physical therapy and case management consultation in reducing hospital admissions

et al. 2020

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Background A significant number of patients who present to the emergency department (ED) following a fall or with other injuries require evaluation by a physical therapist. Traditionally, once emergent conditions are excluded in the ED, these patients are admitted to the hospital for evaluation by a physical therapist to determine whether they should be transferred to a sub‐acute rehabilitation facility, discharged, require services at home, or require further inpatient care. Case management is typically used in conjunction with a physical therapist to determine eligibility for recommended services and to aid in placement. Objective To evaluate the benefit of using ED‐based physical therapist and case management services in lieu of routine hospital admission. Methods Retrospective, observational study of consecutive patients presenting to an urban, tertiary care academic medical center ED between December 1, 2017, and November 30, 2018, who had a physical therapist consult placed in the ED. We additionally evaluated which of these patients were placed into ED observation for physical therapist consultation, how many required case management, and ED disposition: discharged home from the ED or ED observation with or without services, placed in a rehabilitation facility, or admitted to the hospital. Results During the 12‐month study period, 1296 patients (2.4% of the total seen in the ED) were assessed by a physical therapist. The mean age was 75.5 ± 15.2 and 832 (64.2%) were female. Case management was involved in 91.8% of these cases. The final patient disposition was as follows: admission 24.3% (95% CI = 22.1–26.7%), home discharge with or without services 47.8% (95% CI = 45.1–50.5%), rehabilitation (rehab) setting 27.9% (95% CI = 25.6%–30.4). The median (interquartile range) time in observation was 13.1 (6.0–20.3), 9.9 (1.8–15.8), and 18.4 (14.1–24.8) hours for patients admitted, discharged home, or sent to rehabilitation ( P < 0.001). Among the 979 patients discharged home or sent to rehabilitation, 17 (1.7%) returned to the ED within 72 hours and were ultimately admitted. Conclusion Given that the standard of care would otherwise be an admission to the hospital for 1 day or more for all patients requiring physical therapist consultation, an ED‐based physical therapy and case management system serves as a viable method to substantially decrease hospital admissions and potentially reduce resource use, length of hospital stay, and cost both to patients and the health care system.

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It's time to mobilize: Moving mobility interventions for delirium from inpatient units to the emergency department

Kennedy

2023

JACEP Open

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Delirium occurs in 10%-15% of all older emergency department (ED) patients and accounts for 1.5 million ED visits annually, yet emergency clinicians miss this diagnosis one third of the time. [1][2][3] For this reason, ED-based delirium research has predominantly focused on improving delirium identification. However, delirium identification alone without a concerted effort to improve management is insufficient to ameliorate the detrimental effects of delirium. One third of hospitalized older adults and up to 80% of critically ill patients have delirium. 4,5 Delirium is associated with higher mortality, future cognitive decline, greater institutionalization, longer hospital lengths of stay, and greater costs of care. 5,6 Accordingly, it is critical that we implement evidence-based interventions to decrease incident delirium and delirium duration. Non-pharmacologic delirium prevention programs in inpatient wards, which include early mobility, have been shownto prevent approximately half of incident delirium and may decrease inpatient falls, hospital lengths of stay, and costs of care. 7,8 Delirium prevention bundles in inpatient wards and ICUs, which also address mobility, have been demonstrated to reduce mortality and decrease delirium duration. 9,10 However, there is limited research investigating delirium prevention and no research into delirium treatment initiated in the ED. 11 In this issue of JACEP Open, Jordano et al examined the impact of physical therapy (PT) and/or occupational therapy (OT) on delirium duration among ED patients admitted to the hospital. This was a secondary analysis of the prospective cohort study by Han et al funded by the National Institute on Aging, which enrolled a total of 228 patients, of which 105 had delirium, 47 had subsyndrome delirium, and 76 were not delirious in the ED. 12 This secondary analysis was restricted to 130 patients who received PT/OT during their hospitalization. The authors report that the time spent with PT/OT relative to hospital length of stay, termed "PT/OT intensity," was associated with a significant reduction in delirium duration (adjusted odds ratio [OR] = 0.39; 95% confidence interval [CI]: 0.21, 0.73). However, time to initiation of PT/OT was not associated with delirium duration (adjusted OR = 1.02; 95% CI: 0.82, 1.27). What makes this study particularly noteworthy is the inclusion of patients diagnosed with delirium in the ED-to the best of our knowledge presently, this is the only study to examine the effect of PT/OT as a treatment for delirium in ED patients who were hospitalized.Several key limitations of the Jordano et al study merit scrutiny. The

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Physical therapy in the emergency department: A new opportunity for collaborative care

Cited by 27 publications

References 31 publications

The Essential Role of Home- and Community-Based Physical Therapists During the COVID-19 Pandemic

The Essential Role of Home- and Community-Based Physical Therapists During the COVID-19 Pandemic

The utility of emergency department physical therapy and case management consultation in reducing hospital admissions

It's time to mobilize: Moving mobility interventions for delirium from inpatient units to the emergency department

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