Physical Therapy in the Emergency Department

PT in the ER: A New Area of Practice for the Profession

A PT may help you while in the emergency room.
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Oh no! You are playing soccer and land wrong from a jump, twisting your ankle. It immediately hurts, becomes swollen and bruised, and walking is difficult. You decide to head over to the emergency department at your local hospital to determine if your ankle is broken or sprained, or if some other injury has occurred. After a series of x-rays determines there is no fracture, the doctor informs you that you have suffered a bad ankle sprain, and a physical therapist will be in to see you.

Wait. A physical therapist, in the emergency department?

Yes.

Physical therapy in the hospital emergency room is a growing area of practice in the PT profession. Physical therapists in the ER can help patients start on the road to recovery early in the injury process, possibly improving initial functional mobility and overall outcomes.

Functions of the Emergency Room Physical Therapist

What does a physical therapist do in the emergency room? How could a PT possibly help during the first few hours of an injury? Doesn't some amount of healing need to take place prior to starting physical therapy?

Almost half of all visits to the emergency room are classified as non-urgent or semi-urgent, and many visits to the ER are made due to musculoskeletal problems. That's where physical therapists come in. A patient with a non-urgent musculoskeletal problem can safely be triaged to a physical therapist for assessment and treatment.

Physical therapists in the hospital emergency room can provide many vital functions. These may include:

  • Patient education about your injury or illness and how that affects your mobility
  • Education about the expected course of healing for your injury
  • Instruction in bed mobility, transfers, and walking
  • Instruction in using your assistive device, like a cane or a walker
  • Provide exercises to help treat you condition
  • Provide pain relief recommendations, like when—and if—to use ice or heat for your injury

An emergency room physical therapist can help improve your mobility and help you feel better, so when it is time to leave the hospital, you are armed with the right tools to have maximum safe functional mobility.

Which Patients in the ER May Require Physical Therapy?

Obviously, not every patient who enters the emergency department is a candidate for an ER physical therapy visit. Some conditions require life-saving medical interventions where the main goal is to simply preserve life. But other patients enter the hospital emergency room with conditions the are painful and limit mobility, but are also not life threatening. These patients may benefit from the skilled services of a PT in the emergency department before being discharged home.

Patients with certain types of diagnoses may benefit from PT in the emergency room. These may include:

  • Lower extremity sprains, strains, or other injuries: If you suffer a minor ankle or knee injury, you may require crutches or a cane to walk when you leave the ER. A physical therapist can help you learn to use your assistive device properly, and he or she can ensure that the device is the right size for you. Even in the case of a lower extremity fracture, your PT can work with you in the ER prior to going home to make sure you can get around safely.
  • Shoulder, wrist, or elbow injuries: After a fall or other serious upper extremity trauma, you may go the the ER for evaluation, and your doctor may prescribe a sling for you to wear as things are healing. Your PT can show you how to don and doff your sling, and he or she may be able to teach you hand gripping exercises—like the towel grip—to help you maintain hand function while you are wearing your sling.
  • Patients with back or neck pain: Many people who develop acute back pain or spasms report to their local emergency department. Once a serious pathology—like a vertebral fracture—is ruled out, you may benefit from working with a physical therapist to learn which exercises and postural correction strategies are best to start on treatment. In fact, research indicates that starting PT early after onset of back pain can help you recover more quickly and save overall healthcare dollars.
  • After motor vehicle accidents: After a car accident, you may go to the ER for an assessment. A physical therapist in the emergency room can show you exercises (once significant traumatic injury is ruled out) to help you maintain pain-free neck motion.
  • Patients who are at risk for falling: Falling is a serious problem for people who have compromised mobility and for older persons. If you have fallen, you may visit the emergency department to rule out a significant injury. A physical therapist there can show you exercises to improve balance and can teach you fall prevention strategies.

Basically, any patient in the emergency department who has limited functional mobility as the result of an injury or illness may benefit from a physical therapy assessment and intervention prior to being discharged. Once a doctor rules out a significant injury and your injury is classified as semi-urgent or non-urgent, you may benefit from working with a physical therapist to start on the road to recovery.

Outcomes With PT in the Emergency Room

Can physical therapy services in the hospital emergency department have positive outcomes? Maybe. The use of PT in the hospital emergency department is a relatively new area of practice, and current studies examining the effect there are lacking. Some initial anecdotal studies indicate a positive—and safe—outcome can be achieved by the use of physical therapists in the hospital ER and may possibly reduce hospital re-admission rates and hospital length of stay. More high quality studies need to be done to fully ascertain the full benefit of PT practice in the emergency room.

If you have an injury that needs immediate medical care, go to your nearest emergency department. If your condition is deemed non-urgent, don't be surprised if an emergency room physical therapist works with you to start you on the road to recovery quickly and safely.

Sources:

Fritz, J. et al. Early Physical Therapy vs Usual Care in Patients With Recent-Onset Low Back PainA Randomized Clinical Trial.JAMA, 2015;314(4): 1459-67.

Physical Therapist Practice in the Emergency Department. (n.d.). http://www.apta.org/EmergencyDepartment/

Villegas, A. Physical Therapy in the Emergency Department. Capstone physical therapy project. University of New Mexico, Department of PT. 2016.

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