Objective: Emergency Departments (EDs) are currently a main provider of treatment for minor injuries, and annual attendances are expected to increase (The College of Emergency Medicine, 2008). Advanced... [ view full abstract ]
Objective: Emergency Departments (EDs) are currently a main provider of treatment for minor injuries, and annual attendances are expected to increase (The College of Emergency Medicine, 2008). Advanced practice physiotherapists (APPs) are well established within EDs in the UK, with growing evidence on their effectiveness in managing minor injuries as a first point of contact (McClellan et al, 2012). The aim of this report is to evaluate the effectiveness of a first contact physiotherapist (FCP) in a minor injury unit (MIU) on patient waiting times, unscheduled return appointments, referrals to the ED consultant and referral onwards to physiotherapy.
Methods: The FCP was put into post in October 2016. Data typically gathered by the MIU on a monthly basis includes overall time spent in ED, unscheduled return appointments and referrals to the ED consultant clinic. This data was collected from October 2016 to March 2017 and compared to the same period 1 year previous. Data on overall patient waiting times and ED consultant referrals was analyzed using independent t-tests. Unscheduled return appointments and referrals to physiotherapy were analyzed descriptively. Ethical clearance and informed consent were not obtained due to this report being classified as a service evaluation.
Results: Overall the FCP saw 11% (n=382) of all new patient presentations to the MIU during her working hours. 47% (n=180) of patients seen by the FCP were completely discharged the same day. Only 17% (n=65) returned for review for either physiotherapy or further assessment. There was a significant improvement in the overall time spent in ED since the addition of the FCP, with an increase of 25% (n=631) of patients being managed within 65 minutes (p=0.02). This is despite there being an increase in the number of patients visiting the unit compared to the previous year (n=570). There was also a significant reduction in referrals to the ED consultant review clinic compared to the same period 1 year previous (n=135, p=0.01). Only 3% of patients (n=12) seen by the FCP were referred to the ED consultant clinic. There were no patients referred to usual physiotherapy in the MIU. The FCP provided fast access physiotherapy within 1 week for 107 urgent patients referred by the Non-Consultant Hospital Doctor (NCHD). The overall unscheduled return rate for new patients seen by the FCP was 3% compared to MIU average of 4%.
Conclusion: This service report demonstrates the benefit of a FCP in addition to NCHDs on patient care and flow in a MIU setting.
References:
College of Emergency Medicine. (2008) The way ahead 2008-2012: Strategy and guidance for emergency medicine in the United Kingdom and the Republic of Ireland. London: College of Emergency Medicine.
McClellan C.M, Cramp F, Powell J,Benger J.R. (2010) Extended scope physiotherapists in the emergency department: a literature review. Physical Therapy Reviews. 15 (2): 106-111.
