From the 2021 HVPAA National Conference
Katherine Rief (NewYork-Presbyterian Hospital), James Kenny (Columbia University Irving Medical Center), Ellen Sano, Helen Chae, Linda Gundersen, Betty Chang, Clare Bassile, Nicholas Gavin
Background
Incorporating a physical therapist (PT) into an interdisciplinary Emergency Department (ED) team has been shown to improve patient and provider satisfaction but limited data exists to quantify the impact of a dedicated PT on ED patient flow. We hypothesized a dedicated PT in the ED would reduce hospital admissions.
Objective
Assess the impact of a dedicated full-time physical therapist on patient disposition from the ED after PT evaluation.
Methods
We performed a retrospective analysis of 171 patients seen by a PT working in a single large academic ED from August to November 2019. Inclusion criterion was a Physical Therapy (PT) order being placed while the patient was located in the ED. Age and reason for PT order was recorded for all patients. This cohort included active ED patients under evaluation by ED providers, as well as admitted patients boarding in the ED being managed by inpatient teams. For active ED patients, the anticipated patient disposition (discharge, admit or “unsure”) was recorded by the ED provider at the time of PT order. The ultimate disposition within 1 day of PT evaluation was recorded for all patients.
Results
171 patients were evaluated by PT in the ED during the study period. 101 (59.1%) were active ED patients and 70 (40.9%) were boarding in the ED awaiting inpatient beds. The mean age of all patients was 75 years and 82% of patients were ≥65 years old. 25% of PT evaluations were ordered for falls or gait issues. The remaining reasons were a variety of musculoskeletal or medical problems. Anticipated dispositions for active ED patients were: 34 (33.6%) discharge, 14 (13.9%) admit, and 53 (52.5%) “unsure.” 30 of 101 active ED patients (29.7%) seen by PT in the ED had a change between the anticipated and ultimate dispositions after evaluation. 24 of 30 (80%) changed from plan to admit or “unsure” to discharge from the ED. The other 6 (20%) changed from plan to discharge to hospital admission based on PT’s recommendation to place in subacute rehabilitation. 17 of 70 boarding patients (24.3%) had a same-day discharge from the ED after a PT evaluation.
Conclusions
Incorporating a PT into the ED team has the potential to assist clinicians with appropriate disposition decisions, avoid preventable hospital admissions as well as expedite same-day discharge of boarding patients. Our cohort was largely comprised of patients ≥65 years old and a focus on the impact an ED-based PT evaluation has on the disposition of this growing and vulnerable population is a necessary area of future investigation.
Clinical Implications
Having a physical therapist evaluate patients in the ED may expedite a patient’s comprehensive evaluation. In some cases, this can prevent the need for admission to the hospital, which has the potential to reduce costs for the patient and healthcare system, improve patient flow through the ED by improving the availability of inpatient beds, as well as decrease a patient’s exposure to various iatrogenic risks associated with admission.
