PTs in the ER: An Idea Whose Time Has Come?

Physical Therapy in the Emergency RoomA slowly emerging trend in healthcare is the addition of Physical Therapists as permanent staff members in ERs and EDs across the country. About seven states employ full-time PTs in their hospital ERs with Indiana, Missouri and Arizona leading the way, while other states’ hospitals have expanded their on call PT consultations. This novel approach is the direct result of significant shifts in the healthcare delivery system in the United States. Nowadays the ERs/EDs, and not the family physician, are the primary healthcare choice for patients, particularly those lacking the resources and/or access to other avenues of care. Studies have shown that the inclusion of PTs in the ER results in higher patient satisfaction and reduced wait times, thus reducing ER physician workloads. The average wait time in an American ED is 1 hour and the average total length of stay for the patient is 4 hours. On the other hand, the ER/ED physician spends on average only 11 minutes with his patient, including time for diagnosis, research, orders and referrals. Doctors are clearly overtaxed and patients are clearly underserved.

Many of these ERs have been reporting an upsurge in cases presenting with musculoskeletal complaints. Some are life-threatening injuries due to trauma, but the bulk of these are nonemergent or minor injury cases. In those incidences, the ER physician is most likely to order multiple imaging tests, immobilize the patient and then discharge to home with a prescription for bed rest. Needless to say, the majority of sprained ankles and knees or chronic back and neck pains, don’t require advanced imaging or long-term immobilization. It is at this point that the PT’s expertise is most effective in evaluating the patient’s physical condition and recommending a comprehensive treatment plan to be implemented upon discharge with outpatient follow up. PTs bring their knowledge and use of treatments such as spinal manipulation, joint mobilization, therapeutic exercise programs and the PRICE method (protection, rest, ice, compression, elevation) to educate their patients, ensure a speedy recovery and prevent reoccurrences or re-injuries.

The major sticking point preventing more hospitals from hiring PTs as full-time ER staff seems to be a billing issue. Each institution must decide whether or not to provide PT services without a separate charge or to bill for these services as outpatient care. As yet, there is no uniform national consensus as to which method is more financially advantageous and the most efficient for hospitals. North Shore-Long Island Jewish Hospital leans towards not charging for PT services citing savings from prevention of unnecessary admissions and the capturing of downstream revenue from outpatient follow-ups.

The ER is not for everyone, but if you are looking for a new and innovative use of your talents or just want to explore other therapeutic settings we can help. Contact Centra today at 800 535 0076.

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