Physiotherapists in emergency departments: responsibilities, accountability and education

doi:10.1016/j.physio.2012.05.003

Physiotherapy

Volume 99, Issue 2, June 2013, Pages 95-100

https://doi.org/10.1016/j.physio.2012.05.003 Get rights and content

Abstract

Emergency physiotherapy roles have evolved within the UK and are increasingly being adopted in Australia in response to a need for greater workforce flexibility and improved service provision to meet growing patient demand. This paper discusses the need for the physiotherapy profession to develop evidence-based regulatory, ethical and educative frameworks to keep pace with the changing clinical environment and service delivery in emergency departments.

Definitions of Emergency Physiotherapy as either advanced practice or extended scope of practice are identified, and the implications for both regulation of practice and education are highlighted. Suggestions for education in areas of clinical skills, ethical understanding and legal and professional knowledge are highlighted as important areas to support physiotherapists moving into this area of practice.

Section snippets

Overview: the development of physiotherapy in Australian Emergency Departments

Historically, the ED is defined as “the dedicated area in a public hospital that is organised and administered to provide emergency care to those in the community who perceive the need for or are in need of acute or urgent care” [16, p. 199]. In Australia, EDs are legally required to provide basic health care, 24 hours a day regardless of the patients ability to pay and whether their need represents an emergency or not [17]. There is no restriction to the number of people presenting to an ED and

EP as a subset of contemporary physiotherapy practice

In Australia EP has focused on two key roles which are subsets of assessment, diagnosis and clinical reasoning skills [3] care coordination and soft tissue injury specialisation [5]. In care coordination, physiotherapists use their clinical reasoning skills to screen, assess and refer patients to prevent unnecessary hospital admissions [5]. This includes acting as a secondary contact practitioner to assess suitability for discharge with respect to mobility status and falls risk, following

Emergency physiotherapy role and the regulatory framework

As primary healthcare practitioners, physiotherapists operate within a layered regulatory framework including notions of professionalism, codes of ethics and the law [35], [36], [37]. Notions of professionalism broadly include communication skills, ethics knowledge, ongoing commitment to learning and awareness of relevant laws for clinical practice [36], [38].

Professional codes of ethics provide more definitive guidelines for practice, although they also require specification in different

Emergency physiotherapy role and education

The physiotherapy ethos and practice paradigm has developed from educational activities where propositional facts and practical skills framed goals and intentions of treatment [55]. The integral role of education in shaping practice is significant when considering how to develop curricula supporting expansion of physiotherapists into new workplace settings. In 2004, the APA recommended advanced practice physiotherapists have a minimum of 5 years clinical experience post entry-level

Conclusion

In Australia, debate about whether Emergency Physiotherapy should be defined as either advanced practice or extended scope is ongoing. This debate extends to uncertainty about regulation and highlights a need for education to clarify and support this area of clinical practice. This paper provides an overview of role definitions for Australian EPs and implications of this new area of practice, for regulation and education. We suggest there is a need for the physiotherapy profession to develop

References (57)

S. Anaf et al.
Physiotherapy as a clinical service in emergency departments: a narrative review
Physiotherapy
(2007)
N. Taylor et al.
Primary contact physiotherapy in an emergency department can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial
Physiotherapy
(2011)
S. Anaf et al.
Lost in translation? How patients perceive the extended scope of physiotherapy in the emergency department
Physiotherapy
(2010)
J. Moskop et al.
An ethics curriculum for teaching emergency medicine residents
Annals of Emergency Medicine
(1990)
K.J. Sullivan et al.
A vision for society: physical therapy as partners in the National Health Agenda
Physical Therapy
(2011)
I. Edwards et al.
Clinical reasoning strategies in physical therapy
Physical Therapy
(2004)
I. Edwards et al.
New perspectives on the theory of justice: implications for physical therapy ethics and clinical practice
Physical Therapy
(2011)
McPherson P, Kersten P, George S, Lattimer V, Ellis B, Breton A, et al. Extended roles for allied health professionals...
Australian Institute of Health and Welfare [AIHW]
Australian hospital statistics 2007–2008
(2009)

D. Taylor et al.

A paradigm shift in the nature of care provision in emergency departments

Emergency Medicine Journal

(2004)

C. McClellan et al.

Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in an adult emergency department

Emergency Medicine Journal

(2006)

M. Lebec et al.

The physical therapist as a musculoskeletal specialist in the emergency department

Journal of Orthopedic and Sports Physical Therapy

(2009)

C. McClellan et al.

Clinical and cost effectiveness of different emergency department healthcare professionals in the management of musculoskeletal soft tissue injuries

Emergency Medicine Journal

(2009)

C. McClellan et al.

Extended scope physiotherapists in the emergency department: a literature review

Physical Therapy Reviews

(2010)

Centre for Allied Health Evidence [CAHE]

Systematic review of literature on extended scope physiotherapy

(2008)

K. McPherson et al.

A systematic review of evidence about extended roles for allied health professionals

Journal of Health Service Research and Policy

(2006)

Australian Institute of Health and Welfare National Data Committee [AIHWNDC]

National Health Dictionary – version 12

(2003)

Department of Health and Ageing [DHA]

Australian health care agreements

(2007)

L. Johnson et al.

Emergency departments: an emerging context of australian allied health practice

Journal of Allied Health

(2009)

D. Richardson et al.

Myth versus fact in emergency department overcrowding and hospital access block

Medical Journal of Australia

(2009)

Australian Health Workforce Advisory Committee [AHWAC]

Health workforce planning and models of care in emergency departments

(2006)

N. Christensen et al.

Dimensions of clinical reasoning capability

J. Bethel

The role of the physiotherapist practitioner in emergency departments: a critical appraisal

Emergency Nurse

(2005)

E. Kilner et al.

The ‘lone ranger’: a descriptive study of physiotherapy practice in Australian emergency departments

Physiotherapy

(2010)

Australian Physiotherapy Association [APA]

Scope of practice: position statement

(2009)

SA Health

Allied health scope of practice tool

(2009)

H. Madill et al.

Developing competencies for advanced practice: how do I get there from here?

Cited by (29)

Developing an international competency and capability framework for advanced practice physiotherapy: a scoping review with narrative synthesis
2024, Physiotherapy (United Kingdom)
The need to address increasing numbers of people seeking care, insufficient numbers of physicians, and providing high-value and sustainable care has contributed to changing physiotherapy practice across the world, often referred to as advanced practice physiotherapy. Currently, there is no internationally standardized competency and capability framework to support advanced practice physiotherapy.
This scoping review has two aims; 1) To identify and map out the competencies of advanced practice physiotherapy available in the literature. 2) To develop a competency and capability framework by mapping the competencies identified from the review.
The Arksey and O'Malley framework and the PRISMA Scoping review methodology were used. Databases searched included CINAHL Plus, MEDLINE Ovid, PubMed, and Scopus. The competency and capability framework was developed through a narrative synthesis approach.
Nineteen documents were included in the final review, with 13 grey literature (government reports, policy documents, thesis) and six research papers. Included publications came from the United Kingdom, Ireland, Australia, New Zealand, and Canada. The included documents covered predominantly musculoskeletal practice (n = 17). The others focused on cardiorespiratory care, incontinence and pelvic health. Through narrative synthesis, 27 competencies and capabilities were identified and grouped under seven domains.
The synthesis of this scoping review provides the first competency and capability framework for advanced practice physiotherapy that integrates competencies and capabilities from five different countries. With the expansion of advanced practice physiotherapy, the framework developed from this review is the first step towards international recognition, standardization and consistency of education and training of practitioners.
- •
  This paper provides an international competency and capability framework to support the global standardization of advanced practice physiotherapy.
- •
  This paper integrates advanced practice physiotherapy competencies and capabilities from five countries with established advanced practice roles into a single competency and capability framework.
- •
  This paper highlights the value of global standardization of the competencies for advanced practice physiotherapists' education and training.
Identifying the activities of physiotherapy practitioners through primary and secondary models of care provided in New South Wales emergency departments
2022, Australasian Emergency Care
Citation Excerpt :
Traditionally, physiotherapists in Australian EDs have functioned in a secondary contact (SC) care capacity, employed by the Physiotherapy Department or more recently by models specific for aged care as in aged services emergency team and rapid response services (RRS), with both models requiring the SC to respond to referrals made by a doctor for physiotherapy assessment and management [7–9]. In addition to managing musculoskeletal injuries, physiotherapists in SC roles assist the ED team with assessment, treatment and discharge of a variety of complex patients [8]. This includes gait training and disposition planning [10], care co-ordination and discharge planning [8,11], treating vestibular, cardio-respiratory and neurological conditions [6] and providing education to patients [12].
Following the introduction of the emergency department (ED) primary contact physiotherapy role, emergency physiotherapy models of care have evolved and are increasingly being adopted in the Australian ED. This has occurred due to growing ED patient demand and a need for greater workforce flexibility. Since introduction, there here has been limited evaluation of the scope of work physiotherapists are providing in Australian ED.
To identify the activities of ED physiotherapists provided through different models of care in NSW.
Prospective observation study in 19 participating EDs conducted over 6 months between September 2014 and April 2015.
The study identified different models of care across participating hospitals where physiotherapists worked independently or in conjunction with a team through a referral service. The individual’s scope of work was determined by organisational policy, culture, individual competence, knowledge and skills, and varied significantly between sites.
These findings could guide both ED work flow and the development of multidisciplinary workforce structures to improve the utilisation of the physiotherapy service in EDs. This will allow for better service levels in hospitals, better access for patients and better use of resources.
Knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy: A systematic scoping review
2021, Epilepsy and Behavior
Citation Excerpt :
The studies selected in this review were conducted in different settings in Europe, North America, Latin America, Africa, and Asia. With the continuous expansion of the physiotherapy services, physiotherapists are important healthcare providers in different healthcare systems around the world [13,14]. The studies included in this review highlighted some high and low awareness areas among physiotherapists and physiotherapy students with regard to the nature of epilepsy, prevalence and incidence of the disease, consequences of seizures, and management strategies.
In today’s healthcare systems, physiotherapists are one of the most important providers of care services to patients with disabilities including those with epilepsy. The aims of this systematic scoping review were to identify, summarize, and present narrative synthesis of qualitative evidence on knowledge, attitudes, and practices of physiotherapists toward epilepsy and patients with epilepsy.
Primary studies were searched in Medline/PubMed, Embase, Science Direct, SpringerLink, CInAHL/EBSCO, Cochrane library, and Scopus as late as July 02, 2021. Appraisal of the methodological quality was conducted for the studies included in this systematic scoping review. Due to the heterogenous nature of the collected data, results of this study are presented as narrative synthesis.
A total of 11 were finally included in the qualitative synthesis. The selected studies were published in the period between 2016 and 2020. The studies included in this review had acceptable methodological quality in many of the 11 domains of the quality assessment tool. Contents of the included studies were grouped into the 11 themes and 8 subthemes. The major themes were related education/access to information, interaction with patients, witnessing seizures, barriers and promoters of adequate knowledge and attitudes, and interventions to improve knowledge and attitudes.
Currently, high-quality interventional studies are needed to improve knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy. Future studies are still needed to investigate if improving knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy can improve health-related outcomes of the patients.
Implementing models of care for musculoskeletal conditions in health systems to support value-based care
2020, Best Practice and Research: Clinical Rheumatology
Citation Excerpt :
In high-income settings, these examples of new cadres who are educated and authorised to function autonomously and collaboratively in advanced and extended clinical roles may help to achieve some of the quadruple aims of value-based care. These may include reducing wait times in emergency departments, triaging to surgical consult for total knee or hip joint replacement, re-fracture prevention assessments and investigation, and performing as the lead health professional in supporting people presenting with acute low back pain [109–121]. Ongoing evaluation of clinical, economic and patient experience outcomes will be important to maintain momentum in optimising workforce configurations.
Models of Care (MoCs), and their local Models of Service Delivery, for people with musculoskeletal conditions are becoming an acceptable way of supporting effective implementation of value-based care. MoCs can support the quadruple aim of value-based care through providing people with musculoskeletal disease improved access to health services, better health outcomes and satisfactory experience of their healthcare; ensure the health professionals involved are experiencing satisfaction in delivering such care and health system resources are better utilised. Implementation of MoCs is relevant at the levels of clinical practice (micro), service delivery organisations (meso) and health system (macro) levels. The development, implementation and evaluation of MoCs has evolved over the last decade to more purposively engage people with lived experience of their condition, to operationalise the Chronic Care Model and to employ innovative solutions. This paper explores how MoCs have evolved and are supporting the delivery of value-based care in health systems.
Advanced musculoskeletal physiotherapy practice: Informing education curricula
2020, Musculoskeletal Science and Practice
Citation Excerpt :
Additionally, an apprenticeship model for advanced practitioners to help standardise education is currently under development in the UK (Chartered Society of Physiotherapists, 2017). Adoption of standardised MSK APP competencies internationally would promote consistent use and recognition of the advanced practice title, and enable physiotherapists to demonstrate capability to competently and safely undertake tasks at an advanced practice level (Lahey and Currie, 2005; Crane and Delany, 2013). To design competency-based education, which is increasingly being used in the education of advanced practitioners (Skinner et al., 2015; Broome, 2015; Bergstrom and Lindh, 2018), Parson et al. (2018) recommended the following steps: (1) identification of the required APP competencies, (2) organisation of competencies into themes, (3) organisation of themes into courses, and (4) organisation of courses into curricula.
Physiotherapists are operating at an advanced level of practice, usually on ad hoc basis with inhouse training, in response to the increasing burden of musculoskeletal (MSK) disorders. Discrepancies in role-specific education of advanced practice physiotherapists (APPs) creates challenges in ensuring a quality service, workforce mobility and formal recognition. This study reviewed existing MSK APP competency frameworks and education offerings, and explored physiotherapist learning needs with a view to informing international standardisation of MSK APP education curricula.
A scoping review of the literature and relevant university and regulatory websites identified APP competency frameworks and education curricula, which were verified by international experts. Content analysis, performed on the identified competencies and modules, produced a list of themes existing in MSK advanced practice internationally. A survey based on those themes identified the learning priorities of physiotherapists (n = 25) participating in an APP symposium in Ireland.
Six APP competency frameworks and eleven curricula from the UK, Canada and Australia were identified. Themes emerging, regarding MSK APP practice internationally, included both entry-level physiotherapy (e.g., Assessment and Diagnosis) and traditionally medically-controlled tasks (e.g., Injection Therapy), as well as Research, Leadership, Service Development, Professional-related Matters and Education. Participating physiotherapists more commonly prioritised competencies which would be deemed beyond entry level physiotherapy skills (i.e., Radiology versus Manual Therapy).
Despite variances in profiles of APPs both between and within countries, common themes emerged regarding their expected competencies and skills. This study provides the foundation for the adoption of internationally-recognised MSK APP competencies and education standards.
Multi-professional image interpretation: Performance in preliminary clinical evaluation of appendicular radiographs
2019, Radiography
Citation Excerpt :
The application of PCE into the scope of Prectice of other healthcare professions in the acute setting requires workforce development and professional body guidance documents specific to individual roles. At present, studies8–12 have shown the potential for radiographers to produce PCEs, with limited up to date literature demonstrating the image interpretation ability of other healthcare professionals13–21 involved with the treatment and management of patients requiring radiographic imaging for trauma. The College of Paramedics21 definition of the role of an advanced paramedic practitioner, in line with the Royal College of Emergency Medicine ACP pathway22 for managing patients through accident and emergency (A&E) and urgent care pathways, includes requesting radiographic examinations and image interpretation.
The study evaluated the performance of a cohort of healthcare professionals in image interpretation of appendicular radiographic examinations following a preliminary clinical evaluation (PCE) course.
A systematic review and meta-analysis of image interpretation performance by non-medical staff was undertaken. Thirty three participants (seven radiographers, nineteen nurses, five paramedics, and two physiotherapists) completed an image based Objective Structured Examination (OSE) following a short course on PCE of appendicular radiographs. The case bank comprised 25 appendicular radiographic examinations. Prevalence of abnormal examinations approximated 52% (traumatic conditions). The OSE test scores were analysed with Alternative Free-response Receiver Operating Characteristic (AFROC) calculation of Area Under the Curve (AUC), sensitivity, specificity, and Cohen's Kappa (k) for multi-reader agreement. Professional subgroup results were compared with Analysis of Variance (ANOVA), and compared to the literature review.
The participant subgroup results for radiographers were sensitivity 79.7%, specificity 92.9%, k = 72; AUC 86.5. Nurses sensitivity 76.2%, specificity 80.4%, k = 56; AUC 78.3. Paramedics sensitivity 80.3%, specificity 81.6%, k = 61; AUC 81.5. Physiotherapists sensitivity 90.4%, specificity 91.6%, k = 82; AUC 91.8. ANOVA Samples scores (f = 1.5; p = 0.23), sensitivity (f = 0.5; p = 0.65), specificity (f = 2.8; p = 0.05). The comparison of the radiographers and nurses results to the published literature were encouraging (SROC AUC 93.1 and 91.2, respectively). The paramedics and physiotherapists results could not be compared to published standards or abilities on the task due to a lack of literature available.
The study results of image interpretation and commentary of appendicular radiographs in an academic environment by this multi-professional sample were to a high standard, further work is recommended on a larger sample.

View all citing articles on Scopus

View full text

Debate ArticlePhysiotherapists in emergency departments: responsibilities, accountability and education

Abstract

Section snippets

Overview: the development of physiotherapy in Australian Emergency Departments

EP as a subset of contemporary physiotherapy practice

Emergency physiotherapy role and the regulatory framework

Emergency physiotherapy role and education

Conclusion

Physiotherapy

Physiotherapy

Physiotherapy

Annals of Emergency Medicine

A vision for society: physical therapy as partners in the National Health Agenda

Physical Therapy

Clinical reasoning strategies in physical therapy

Physical Therapy

New perspectives on the theory of justice: implications for physical therapy ethics and clinical practice

Physical Therapy

Australian hospital statistics 2007–2008

A paradigm shift in the nature of care provision in emergency departments

Emergency Medicine Journal

Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in an adult emergency department

Emergency Medicine Journal

The physical therapist as a musculoskeletal specialist in the emergency department

Journal of Orthopedic and Sports Physical Therapy

Clinical and cost effectiveness of different emergency department healthcare professionals in the management of musculoskeletal soft tissue injuries

Emergency Medicine Journal

Extended scope physiotherapists in the emergency department: a literature review

Physical Therapy Reviews

Systematic review of literature on extended scope physiotherapy

A systematic review of evidence about extended roles for allied health professionals

Journal of Health Service Research and Policy

National Health Dictionary – version 12

Australian health care agreements

Emergency departments: an emerging context of australian allied health practice

Journal of Allied Health

Myth versus fact in emergency department overcrowding and hospital access block

Medical Journal of Australia

Health workforce planning and models of care in emergency departments

Dimensions of clinical reasoning capability

The role of the physiotherapist practitioner in emergency departments: a critical appraisal

Emergency Nurse

The ‘lone ranger’: a descriptive study of physiotherapy practice in Australian emergency departments

Physiotherapy

Scope of practice: position statement

Allied health scope of practice tool

Developing competencies for advanced practice: how do I get there from here?

Debate Article
Physiotherapists in emergency departments: responsibilities, accountability and education