Stacie Fruth, PT, DHSc, OCS Michael Brickens, PT Tim Ellender, MD Jenny Gojmerac- Owens, NP Julie Welch, MD. Stacie Fruth, PT, DHSc, OCS

Transcription

1 Physical Therapists on the Emergency Department Team: PT and MD Perspec8ves Stacie Fruth, PT, DHSc, OCS Michael Brickens, PT Tim Ellender, MD Jenny Gojmerac- Owens, NP Julie Welch, MD Combined Sec,ons Mee,ng 2015 Friday, 11:00a 1:00p Panel Introduc8ons Stacie Fruth, PT, DHSc, OCS University of Indianapolis; IU- Methodist Hospital Michael Brickens, PT IU- Methodist Hospital Tim Ellender, MD IU- Methodist Hospital Jenny Gojmerac- Owens, NP IU- Methodist Hospital Julie Welch, MD IU- Methodist Hospital Fruth SJ; Not to be copied without permission 1

2 Learning Objec8ves 1. Appreciate the pathway to implementa8on of a successful PT prac8ce in the ED sexng. 2. Summarize descrip8ve, survey, and outcomes studies conducted through IU- Methodist Hospital and recognize the challenges inherent to performing quality, impac[ul, and meaningful research in this sexng. 3. Understand the unique role of the PT in the ED via presenta8on of case studies of pa8ents seen by a PT in this sexng. 4. Appreciate the physician perspec8ve of PT prac8ce in the ED. Indiana University Methodist Hospital Descrip8on of hospital and ED Fruth SJ; Not to be copied without permission 2

3 PT Prac8ce at IU- Methodist Hospital Started PT services in 2002 Currently 2 full- 8me, 4 per diem PTs At least 72 hours of coverage/week 7-10 pa8ents/day Methods of referral Billing PT Prac8ce at IU- Methodist Hospital Developments and adapta8ons over the past 13 years Influence of: Hospital policy Administra8ve demands Direct access Changing landscape of healthcare Fruth SJ; Not to be copied without permission 3

4 EDPT- Focused Research Brief summary of published research to date Rela8ve paucity of research Many from UK, Australia, Sweden, NZ Primarily descrip8ve EDPT- Focused Research Challenges of conduc8ng quality research studies in this sexng One- 8me encounters Control groups Par8cipant recruitment challenges Required MD/PA/NP interac8on Mul8plicity of pa8ent and environmental variables Fruth SJ; Not to be copied without permission 4

5 Ankle sprain (2003) ED prac88oner survey (2005) Pilot whiplash study (2005) Pa8ent sa8sfac8on/opinion (2011) Retrospec8ve analysis of pa8ent diagnoses (2011) ED prac88oner survey (2011) Trends comparing to 2004 survey PT vs. standard care interven8ons (2013) Pa8ent survey with 3 month follow- up (2014) Focus on falls and return visits to the ED Current study Ankle Sprain (2003) Pilot RCT PT interven8on vs. Standard Care N=8 Ini8al interven8on in ED with 2 week/3 month follow up visit Results Fruth SJ; Not to be copied without permission 5

6 Prac88oner Survey (2005) Survey of ED staff MDs, residents, NPs, and RNs Opinions about PT prac8ce in the ED Knowledge of PT prac8ce Opinions about standing PT orders for various condi8ons Pilot experimental study (2005) Acute whiplash (<24hrs post MVC) PT vs. Standard Care (SC) N = 13 7 PT; 6 SC 3- day, 3- month, 6- month follow up Phone survey; Neck Disability Index; Beck Anxiety Inventory Results Fruth SJ; Not to be copied without permission 6

7 Pa8ent survey (2011) Opinions of PT services in the ED N = (69%) completed 2- week follow- up phone survey Pa8ent sa8sfac8on with PT care received Return to ED for same problem Who does PT see in the ED? (2011) Retrospec8ve analysis All pa8ents seen by PT in the ED over one year Total number receiving PT interven8on Diagnos8c categoriza8on Fruth SJ; Not to be copied without permission 7

8 Repeat prac88oner survey (2011) Survey of ED staff MDs, residents, NPs, and RNs Opinions about PT prac8ce in the ED Knowledge of PT prac8ce Opinions about standing PT orders for various condi8ons Compare to previous survey in 2005 PT vs. Standard Care Interven8ons (2013) Collabora8ve study with AZ PTs (Lebec & Schafer) Low back pain, neck pain, ankle sprain 25 PT and 25 SC charts retrospec8ve reviews for each dx area All interven8ons categorized with focus on which were evidence supported Fruth SJ; Not to be copied without permission 8

9 Pa8ent survey (2014) 225 PTED pa8ents recruited 2- week and 3- month phone follow up Focus on reported falls, ED visits for same problem, and sa8sfac8on Small control group Results presented this morning Current study Pa8ent categoriza8on at ED triage desk 75 hours of observa8on 25 each: weekday day, weekday evening, weekend day Preliminary results Fruth SJ; Not to be copied without permission 9

10 PTED Pa8ent Case Examples 3 pa8ent cases will be described Medical Prac88oner Perspec8ves Tim Ellender, MD Value of PT in this sexng Challenges of PT in the sexng Level of concern for added cost? Added 8me? Case example (unique) involving PT with a pa8ent Fruth SJ; Not to be copied without permission 10

11 Medical Prac88oner Perspec8ves Julie Welch, MD Value of PT in this sexng Challenges of PT in the sexng Level of concern for added cost? Added 8me? Case example (unique) involving PT with a pa8ent Medical Prac88oner Perspec8ves Jenny Gojmerac- Owens, NP Value of PT in this sexng Challenges of PT in the sexng Level of concern for added cost? Added 8me? Case example (unique) involving PT with a pa8ent Fruth SJ; Not to be copied without permission 11

12 PT Ques8ons for Medical Prac88oners What variables do you consider when deciding to make a referral to EDPT? Do you have any specific guidelines for this decision? Comment on personal reasons for ordering imaging. Do you feel the need to wait for results prior to referring to EDPT? What are your thoughts on direct EDPT referral from triage desk? Audience Q & A Fruth SJ; Not to be copied without permission 12

13 References Anaf S, Sheppard L. Physiotherapy as a clinical service in emergency departments: a narra8ve review. Physiother.2007;93: Fleming- McConnell D, Czuppon S, Deusinger SS, Deusinger RH. Physical therapy in the emergency department: development of a novel prac8ce venue. Phys Ther. 2010;90: Fruth SJ, Slaven E, Hicks A, et al. Descrip8ve analysis of established physical therapy prac8ce in the emergency department. Pla[orm presenta8on: Combined Sec8ons Mee8ng of the American Physical Therapy Associa8on; San Diego, CA. Fruth SJ, Slaven E, Hicks A, et al. Pa8ent percep8ons of the value and efficacy of interven8ons provided by physical therapists in the emergency department. Poster presenta8on: Combined Sec8ons Mee8ng of the American Physical Therapy Associa8on; San Diego, CA. Fruth SJ, Rogowski D, Wuertemburger E, et al. Comparison of standard care and physical therapy interven8ons for the condi8ons of neck pain presen8ng to the emergency department. Pla[orm presenta8on: Combined Sec8ons Mee8ng of the American Physical Therapy Associa8on; Las Vegas, NV. Fruth SJ, Dennis M, Katz K, et al. Can physical therapy interven8on in the emergency department posi8vely influence pa8ent- reported falls and return visits for the same condi8on? Pla[orm presenta8on: Combined Sec8ons Mee8ng of the American Physical Therapy Associa8on; Indianapolis, IN. Gaieski DF, Mehta S, Hollander JE, et al. Low- severity musculoskeletal complaints evaluated in the emergency department. Clin Orthop Relat Res. 2008;466: References Greenwood R, McClellan C, Benger J. Effect of an extended scope physiotherapy service on pa8ent sa8sfac8on and the outcome of sos 8ssue injuries in an adult emergency department. Emerg Med J. 2006;23: Kesteloot L, Lebec M. Physical therapist consulta8on in the emergency department: A mul8ple case report describing three Arizona programs. J Acute Care Phys Ther. 2012;3: Lebec MT, Cernohous S, Tenbarge L, et al. Emergency department physical therapist service: A pilot study examining physician percep8ons. Internet J Allied Health Sci Pract. 2010;8:1-12. Kilner, E. What evidence is there that a physiotherapy service in the emergency department improves health outcomes? A systema8c review. J Health Serv Res Policy. January 2011;16(1): Mcclellan CM, Greenwood R, Benger JR. Effect of an extended scope physiotherapy service on pa8ent sa8sfac8on and the outcome of sos 8ssue injuries in an adult emergency department. Emerg Med J. 2006;23: Sheppard LA, Anaf S, Gordon J. Pa8ent sa8sfac8on with physiotherapy in the emergency department. Int Emerg Nurs. 2010;18: Taylor NF, Norman E, Roddy Let al. Primary contact physiotherapy in emergency departments can reduce length of stay for pa8ents with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospec8ve non- randomised controlled trial. Physiotherapy. 2011;97: Weisend MJ, Marulli TA, Paz JC. Physical therapists percep8ons of physical therapy in the emergency department. J Acute Care Phys Ther. 2011;2: Fruth SJ; Not to be copied without permission 13