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First contact physiotherapy in ED

Lee Cresswell standing in NHW Emergency Department.
Physiotherapist Lee Cresswell joins the NHW Emergency Department.

A project to embed an Advanced Practice primary contact Physiotherapy service into the Emergency Department at Northeast Health Wangaratta has commenced with the appointment of an Advanced Musculoskeletal Physiotherapist (AMP) to the department.

Advanced Practice Physiotherapy (APP) roles have been successfully implemented across a number of health services in regional Victoria, following the lead of established services at tertiary metropolitan hospitals in Melbourne, such as the Alfred, Austin and Monash Hospitals.

This innovative model aims to address the rising prevalence of non-urgent lower acuity emergency department presentations and associated demand, such as musculoskeletal disorders and acute musculoskeletal injuries.

There is strong evidence that AMP’s can improve patient flow through emergency departments, reducing patient waiting times and length of stay, resulting in a better patient experience and satisfaction. AMPs provide safe and effective care ensuring that clinical best practice is used to manage musculoskeletal presentations. Research has found that primary contact AMP’s spare emergency medical resources, preserving their capacity to focus on high acuity presentations. [i]

The AMP position has been made possible through the Department of Health’s Allied Health Workforce Advance Practice Grant. NHW said these grants are highly competitive and they feel fortunate to receive one.

Lee Cresswell joined the team in July and has spent the last few months setting up the scope of practice and operational guidelines for the service in the Emergency Department.

Lee is an experienced Musculoskeletal Physiotherapist who brings a breadth of clinical knowledge across the public and private sectors to the role. His experience includes as a Senior Physiotherapist and Community Care Manager at Corryong Health Service and Physiotherapy clinical educator and lecturer at both Charles Sturt and Monash Universities.

NHW’s Executive Director of Clinical Operations, Bernadette Hammond, said the emergency department managed 2,336 presentations with orthopaedic / musculoskeletal conditions over a period of 6 months, accounting for approximately 16% of all emergency admissions.

“Embedding a primary contact physiotherapy service should improve access to timely care for people presenting to our emergency department,” Bernadette said.

“We hope to achieve this by reducing wait times and improving flow for patients with orthopaedic and musculoskeletal presentations, freeing up these beds for others requiring urgent, high acuity.”

Implementation of similar services in emergency departments in the UK and Canada led to decreased wait times and up to 63% of referrals to outpatient clinics with appropriate non-surgical management by a physiotherapist.[ii]

Lee said that while it was only early days, the department was already seeing benefits to the flow of patients due to the timely care and discharge of acute musculoskeletal presentations. In the short time the service has been operating, Lee has on average managed five musculoskeletal presentations independently per shift, plus co-managed many more patients who have presented with more complex injuries. These numbers are projected to increase as the weather starts to warm up.

“This is not a service for people who haven’t been able to get into their usual physio for general conditions – it is an acute service dealing with emergency situations,” Lee said.

“It’s a busy emergency department and I have treated a vast range of presentations, from simple fractures and back pain to major muscle and joint injuries. It is exciting to be part of such a supportive and collaborative team”.

[i] (Crane & Delany, 2013; Sayer, 2018)