The impact of introducing a musculoskeletal physiotherapy practitioner role into the emergency department of an acute hospital – A service evaluation

Purpose:
Emergency Department (ED) attendances have been rising, increasing from 16.2 million in 2010/11, to 24.8 million in 2018/19 (NHS digital, 2019). One initiative to meet workforce requirements associated with such increasing demand has been the introduction of advanced physiotherapy practitioner roles to manage musculoskeletal (MSK)/minor injury caseloads (Royal College of Emergency Medicine, 2017) The aim of this service evaluation was to investigate the impact to patients and staff of introducing an MSK physiotherapy practitioner service into the ED of an acute trust.

Methods:
A multisource feedback questionnaire with closed multiple choice and open questions was used to investigate the views of patients, ED staff and management on the impact of introducing MSK physiotherapy practitioners into the ED team at patient, provider and system levels. Questions focused on waiting times, patient satisfaction, impact to staff on their workload/skills/knowledge and cost. Multiple choice answers were descriptively analysed and presented in graphs. Thematic analysis was utilised to explore free text responses.

Results:
A total of 65 questionnaires were completed by 57 patients (seen solely by a physiotherapy practitioner), 6 staff ( x1 band 7 physiotherapist, x4 nurse practitioners, x1 specialty registrar) and 2 management (ED minor injury manager and physiotherapy lead) between November 2019 and January 2020. 93% (n=53) of patient respondents waited less than 2 hours to be assessed. 98% (n=56) of patients rated the care they received as good or excellent, 100% (n=57) of patients rated the physiotherapist’s skills in managing their presenting condition as good or excellent. Staff highlighted that working alongside physiotherapists improved their specialist MSK knowledge and expertise. Staff noticed a reduction in their workload because a wider range of skilled staff were available to manage the ED caseload. Management highlighted physiotherapists have expertise to manage complex MSK conditions and provide expert staff training. No respondents commented on cost implications.

Conclusion(s):
The results from this small-scale evaluation from one acute NHS trust suggest that physiotherapists have a positive impact on patient satisfaction and provide quality care to patients. Most patients waited less than 2 hours to see the physiotherapist, these patients would have previously waited alongside all ED attenders with national average ED waits of 130 minutes prior to 2018 (NHS, 2018). Locally patients wait on average 29 minutes less to see the physiotherapist than other ED staff.
This project does not provide evidence of cost implications of the role. Direct contact costs of physiotherapists have been found as £5 per hour cheaper than doctors. Doctors can see any patient whereas physiotherapy scope is more limited, therefore no significant difference in cost-effectiveness has been found between physiotherapists and routine care (McClellan, 2013). Further research is needed to evaluate whether there is any longer-term cost saving by patients receiving timely expert advice in an ED setting.

Impact:
A 5500-word report and infographic were created as a result of this service evaluation which contributed to a local trust report used to secure funding for 1.6 WTE physiotherapy practitioner posts in the ED. This project highlights an advanced practice career avenue for physiotherapists.