Physical therapy in the emergency department can provide benefits to patients, hospitals, and physicians. It can improve patient satisfaction by reducing wait times and providing education and referrals. It also saves costs by decreasing unnecessary imaging, medication use, and hospital admissions and readmissions. Physical therapists in the ED can help increase productivity by allowing physicians and nurses to focus on other patients while PT evaluates and treats musculoskeletal injuries, falls, balance issues, and more. The document outlines the process for PT referrals and evaluations in the ED, areas of training for ED physical therapists, and physician perspectives on the benefits of PT in emergency care.

1. +
Physical Therapy in the EDChrista Loyd, SPT, MBA
Sarah Nazzaro, PT, DPT
Becca Medina, PT, DPT

2. +
Benefits of physical therapy in the
ED

3. +
Patient Satisfaction
 Wait times
 Patient education
 Outpatient referrals
(Lebec, 2010; Fleming, 2009; Lebec,
2009; Smith, 2010; Morris, 1996)

4. +
Cost Effectiveness
 Decreased use of unnecessary imaging
 Decreased use of pain medication
 Decrease hospital re-admission and admission
(Fleming, 2010; Lebec ,2010; Lebec, 2009)

5. +
Increased Productivity and
Operations
 Increased treatment and service options
 Physicians and nurses can attend to other patients
 Discharge planning

6. +
Types of Conditions managed by ED
PT’s
 MSK injuries
 Peripheral vestibular dysfunction
 Acute or chronic wound care
 Injury from fall/fall prevention
 Neurological deficits
(Childs, 2005; Lebec, 2009;
Smith, 2010; Alghadir, 2012)

7. +
PT Scope of Practice in ED
 Differential diagnosis
 Patient education
 Discharge planning
 Pain management
 Exercise prescription
 Safety assessment
(APTA Guide; Lebec, 2009; Alghadir, 2012)

8. +
Physician Perspectives
“I think that the services are an unrecognized need. I certainly
never would have sought out PT services for the department, and
I’m the medical director… But now that they’re here I can’t
imagine working in a department without them”
“Physical therapists are particularly good at sorting out
musculoskeletal problems that we are not well trained to do”
“Able to provide a more comprehensive diagnosis and treatment
plan than was the norm in the ED”
(Lebec, 2010)

9. +
Process to initiate PT evaluation
1. MD
assessment &
r/o life
threatening
conditions
2. MD/RN refers
to guidelines for
PT consults
3. MD/RN places
electronic order if
appropriate: PT
Eval & Treat
4. ED notifies PT
ASCOM x 2357
5. PT goal: Assess
patient <30 minutes
of phone call.
*Certain situations
will not allow for PT
consult.
6. PT performs
eval & treatment
as appropriate,
discussion of
findings w/ MD &
RN
7. Goal: d/c from
ED (home, IP,
etc)

10. +
Guidelines Patient cleared for all emergent cardiac
issues, all possible emergent
neurological issues, and any possible
fractures?
Suspect
Musculoskeletal
Issues?
Proper Imaging
performed (Ottawa
Ankle/Knee Rules,
Canadian C-spine Rules)
If cleared for fractures
then consult PT to
evaluate and treat
Unsafe to Discharge
Home?
Consult PT if unsure
Suspect Vertigo,
dizziness, or “off
balance”?
Any medication interaction
or incorrect dosages? If
yes, proper consult with
MD or pharmacy.
No
Consult PT for
Vestibular Eval and
Treat
History of Falls?
Consult PT for balance
assessment and safety
recommendations
Suspect other neuro:
Parkinson’s, MS, etc.?
Is patient already
receiving therapy
services?
If not receiving
services then consult
PT at HRRMC

11. +
Areas of Training for PT
 Non-clinical skills
 Differential diagnosis
 Orthopedic management
 Wound care management
 Mobility/fall risk assessment
 Neurovestibular
 Pain management
 Radiology
 Pharmacology

12. +
Recommended Experience
 1-3 years post graduation clinical experience
 Experience in acute care or emergency setting
 Residency program (optional)

13. +References
1. American Physical Therapy Association. Guide to Physical Therapist Practice. Second Edition.
Phys Ther. 2001;81:9-746.
2. Alghadir AH, Iqbal ZA, Whitney SL. An update on vestibular physical therapy. J Chin Med
Assoc. 2012;76:1-8.
3. Lebec MT, Cernohous S, Tenbarge L, Gest C, Severson, K, Howard, S. Emergency Department
Physical Therapist Service: A Pilot Study Examining Physician Perceptions. The International
Journal of Allied Health Sciences and Practice. 2010; 8:1-12.
4. Lebec MT, Jogodka CE. The Physical Therapist as a Musculoskeletal Specialist in the
Emergency Department. Journal of Sports Physical Therapy. 2009;39:221-229.
5. Smith BA, Fields CJ, Fernandez N. Physical Therapists Make Accurate and Appropriate
Discharge Recommendations for Patients Who are Acutely Ill. Phys Ther. 2010; 693-703.
6. Childs JD, Whitman JM, Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical
therapists’ knowledge in managing musculoskeletal conditions. BMC Musculoskelet Disord.
2005;6:32.
7. Fleming-McDonnell D, Czuppon S, Deusinger SS, Deusinger RH. Physical Therapy in the
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426.
8. Morris CD, Hawes SJ. The value of accident and emergency based physiotherapy services. J
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