Management of patients brought in by ambulance to the emergency department: role of the Advanced Musculoskeletal Physiotherapist
Rita Kinsella A D , Tom Collins A , Bridget Shaw A , James Sayer B , Belinda Cary A , Andrew Walby A and Sallie Cowan A CA St Vincent’s Hospital, Physiotherapy Department, Victoria Parade, Fitzroy, Vic. 3065, Australia. Email: Tom.Collins@svha.org.au; Bridget.Shaw@svha.org.au; Belinda.Cary@svha.org.au; Andrew.Walby@svha.org.au
B The Alfred Hospital, PO Box 315, Prahran, Vic. 3181, Australia. Email: j.sayer@alfred.org.au
C The School of Physiotherapy, The University of Melbourne, Parkville, Vic 3010, Australia. Email: s.cowan@unimelb.edu.au
D Corresponding author. Email: Rita.Kinsella@svha.org.au
Australian Health Review 42(3) 309-315 https://doi.org/10.1071/AH16094
Submitted: 25 April 2016 Accepted: 9 March 2017 Published: 9 May 2017
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 9.5 min (interquartile range (IQR) 3.25–18.00 min) compared with 25 min (IQR 10.00–56.00 min) 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.
References
[1] Lowthian JA, Curtis AJ, Jolley DJ, Stoelwinder JU, McNeil JJ, Cameron PA. Demand at the emergency department front door: 10-year trends in presentations. Med J Aust 2012; 196 128–32.| Demand at the emergency department front door: 10-year trends in presentations.Crossref | GoogleScholarGoogle Scholar |
[2] Australian Institute of Health and Welfare (AIHW). Emergency department care 2014–15: Australian hospital statistics. Health Services Series no. 65. Catalogue no. HSE 168. Canberra: AIHW; 2015. Available at: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129553618 [verified 21 August 2016].
[3] Australian Institute of Health and Welfare (AIHW). Australian hospital statistics 2013–14: emergency department care. Canberra: AIHW; 2014. Available at: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129551484 [verified 21 August 2016].
[4] Suarez H, Arocena M, Suarez A, De Artagaveytia TA, Muse P, Gil J. Changes in postural control parameters after vestibular rehabilitation in patients with central vestibular disorders. Acta Otolaryngol 2003; 123 143–7.
| Changes in postural control parameters after vestibular rehabilitation in patients with central vestibular disorders.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3s7ot1Kjsw%3D%3D&md5=c76ee1e485abecb06f15a258102168e6CAS |
[5] Carter EJ, Pouch SM, Larson EL. The relationship between emergency department crowding and patient outcomes: a systematic review. J Nurs Scholarsh 2014; 46 106–15.
| The relationship between emergency department crowding and patient outcomes: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[6] Fatovich DM, Hirsch RL. Entry overload, emergency department overcrowding, and ambulance bypass. Emerg Med J 2003; 20 406–9.
| Entry overload, emergency department overcrowding, and ambulance bypass.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3svhsFaktA%3D%3D&md5=f4ddb2deb3144e18c90bea40029cf3aaCAS |
[7] Forero R, McCarthy S, Hillman K. Access block and emergency department overcrowding. Crit Care 2011; 15 216
| Access block and emergency department overcrowding.Crossref | GoogleScholarGoogle Scholar |
[8] Bernstein SL, Aronsky D, Duseja R, et al The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med 2009; 16 1–10.
| The effect of emergency department crowding on clinically oriented outcomes.Crossref | GoogleScholarGoogle Scholar |
[9] Hitchcock M, Crilly J, Gillespie B, Chaboyer W, Tippett V, Lind J. The effects of ambulance ramping on emergency department length of stay and in-patient mortality. Australas Emerg Nurs J 2010; 13 17–24.
| The effects of ambulance ramping on emergency department length of stay and in-patient mortality.Crossref | GoogleScholarGoogle Scholar |
[10] Australasian College for Emergency Medicine. Position statement on ambulance ramping. 2013. Available at: https://acem.org.au/getattachment/ea260898-9e4b-4c34-a127-d723072bc128/S347-Statement-on-Ambulance-Ramping.aspx [verified 21 August 2016].
[11] Australasian College for Emergency Medicine. Statement on ambulance diversion to manage emergency department or hospital overcrowding. 0000. Available at: https://acem.org.au/getattachment/a66b1406-53d1-4c9e-a064-c62bc90e3bd5/S47-Statement-on-Ambulance-Diversion.aspx [verified 21 August 2016].
[12] Boyle A, Beniuk K, Higginson I, Atkinson P. Emergency department crowding: time for interventions and policy evaluations. Emerg Med Int 2012; 2012 838610
| Emergency department crowding: time for interventions and policy evaluations.Crossref | GoogleScholarGoogle Scholar |
[13] Fatovich DM, Nagree Y, Sprivulis P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J 2005; 22 351–4.
| Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M3gvVOktw%3D%3D&md5=60054062de01d29d91f40c44f42af59dCAS |
[14] Victorian Department of Health. The Victorian health service performance monitoring framework 2013–14: business rules. 2013. Available at: https://www2.health.vic.gov.au/about/publications/policiesandguidelines/The%20Victorian%20Health%20Services%20Performance%20Monitoring%20Framework%202013-14%20Business%20Rules [verified 31 March 2017].
[15] Victorian Department of Health. The Victorian health service performance monitoring framework 2012–13: business rules. 2012. Available at: https://www2.health.vic.gov.au/getfile/?sc_itemid=%7bDAA41393-317A-45C3-9B73-72E6B86FA307%7d&title=TheVictorianHealthServicePerformanceMonitoringFramework2012-13BusinessRules [verified 31 March 2017].
[16] de Gruchy A, Granger C, Gorelik A. Physical therapists as primary practitioners in the emergency department: six-month prospective practice analysis. Phys Ther 2015; 95 1207–16.
| Physical therapists as primary practitioners in the emergency department: six-month prospective practice analysis.Crossref | GoogleScholarGoogle Scholar |
[17] Thompson C, Williams K, Morris D, Bird S, Kobel C, Andersen P, Eckermann S, Quinsey K, Masso M. HWA Expanded Scopes of Practice program evaluation: Physiotherapists in the Emergency Department subprojec:t final report (Australian Health Service Research Institute, Wollongong, Australia) 2014. Available at: http://ahsri.uow.edu.au/content/groups/public/@web/@chsd/documents/doc/uow177108.pdf [verified 31 March 2017].
[18] Bird S, Thompson C, Williams KE. Primary contact physiotherapy services reduce waiting and treatment times for patients presenting with musculoskeletal conditions in Australian emergency departments: an observational study. J Physiother 2016; 62 209–14.
| Primary contact physiotherapy services reduce waiting and treatment times for patients presenting with musculoskeletal conditions in Australian emergency departments: an observational study.Crossref | GoogleScholarGoogle Scholar |
[19] Harding P, Prescott J, Sayer J, Pearce A. Advanced musculoskeletal physiotherapy clinical education framework supporting an emerging new workforce. Aust Health Rev 2015; 39 271–82.
| Advanced musculoskeletal physiotherapy clinical education framework supporting an emerging new workforce.Crossref | GoogleScholarGoogle Scholar |
[20] Australasian College for Emergency Medicine. Policy document on the Australasian Triage Scale 2013. 2013. Available at: https://acem.org.au/getattachment/693998d7-94be-4ca7-a0e7-3d74cc9b733f/Policy-on-the-Australasian-Triage-Scale.aspx/ [verified 31 March 2017].
[21] Gill SD, Stella J. Implementation and performance evaluation of an emergency department primary practitioner physiotherapy service for patients with musculoskeletal conditions. Emerg Med Australas 2013; 25 558–64.
| Implementation and performance evaluation of an emergency department primary practitioner physiotherapy service for patients with musculoskeletal conditions.Crossref | GoogleScholarGoogle Scholar |
[22] Guengerich M, Brock K, Cotton S, Mancuso S. Emergency department primary contact physiotherapists improve patient flow for musculoskeletal patients. Int J Ther Rehabil 2013; 20 396–402.
| Emergency department primary contact physiotherapists improve patient flow for musculoskeletal patients.Crossref | GoogleScholarGoogle Scholar |
[23] Taylor NF, Norman E, Roddy L, Tang C, Pagram A, Hearn K. Primary contact physiotherapy in emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial. Physiotherapy 2011; 97 107–14.
| Primary contact physiotherapy in emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[24] McClellan CM, Greenwood R, Benger JR. Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in an adult emergency department. Emerg Med J 2006; 23 384–7.
| Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in an adult emergency department.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD283itVSitg%3D%3D&md5=3f5999d1e482caac1d97159abea4b12bCAS |
[25] Sheppard LA, Anaf S, Gordon J. Patient satisfaction with physiotherapy in the emergency department. Int Emerg Nurs 2010; 18 196–202.
| Patient satisfaction with physiotherapy in the emergency department.Crossref | GoogleScholarGoogle Scholar |
[26] Kilner E. What evidence is there that a physiotherapy service in the emergency department improves health outcomes? A systematic review. J Health Serv Res Policy 2011; 16 51–8.
| What evidence is there that a physiotherapy service in the emergency department improves health outcomes? A systematic review.Crossref | GoogleScholarGoogle Scholar |
[27] Harding P, Prescott J, Block L, O’Flynn AM, Burge AT. Patient experience of expanded-scope-of-practice musculoskeletal physiotherapy in the emergency department: a qualitative study. Aust Health Rev 2015; 39 283–9.
| Patient experience of expanded-scope-of-practice musculoskeletal physiotherapy in the emergency department: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[28] Gordon J, Sheppard LA, Anaf S. The patient experience in the emergency department: a systematic synthesis of qualitative research. Int Emerg Nurs 2010; 18 80–8.
| The patient experience in the emergency department: a systematic synthesis of qualitative research.Crossref | GoogleScholarGoogle Scholar |
[29] Sutton M, Govier A, Prince S, Morphett M. Research: primary-contact physiotherapists manage a minor trauma caseload in the emergency department without misdiagnoses or adverse events: an observational study. J Physiother 2015; 61 77–80.
| Research: primary-contact physiotherapists manage a minor trauma caseload in the emergency department without misdiagnoses or adverse events: an observational study.Crossref | GoogleScholarGoogle Scholar |
[30] Crane J, Delany C. Physiotherapists in emergency departments: responsibilities, accountability and education. Physiotherapy 2013; 99 95–100.
| Physiotherapists in emergency departments: responsibilities, accountability and education.Crossref | GoogleScholarGoogle Scholar |
[31] McClellan CM, Cramp F, Powell J, Benger JR. Extended scope physiotherapists in the emergency department: a literature review. Phys Ther Rev 2010; 15 106
| Extended scope physiotherapists in the emergency department: a literature review.Crossref | GoogleScholarGoogle Scholar |
[32] World Health Organization. 2014. International statistical classification of diseases and related health problems (10th revision). Available at: http://www.who.int/classifications/icd/icdonlineversions/en/ [verified 21 August 2016].
[33] Victorian Department of Health. Ambulance performance and policy consultative committee. 2015. Available at: https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/ambulance-and-nept/ambulance-action-plan [verified 1 February 2017].
[34] ABS (Australian Bureau of Statistics) 2014. Patient experiences in Australia: Summary of findings 2013–14. ABS cat. no. 4839.0. Canberra: ABS. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4839.0~2013-14~Main%20Features~Hospital%20admissions%20and%20emergency%20departments~5 [verified 31 March 2017].
