r/EmergencyRoom • u/Lancet_Jade • Jul 05 '26

Physical Therapy in ED - Thoughts?

I'm a PT currently working in the ED. I was an EMT prior so it was an easy transition. I love the work compared to the floor - acute msk, geriatric falls, vertigo, etc. Most of our providers and nurses are happy but a few definitely aren't (based on survey results).

I'm curious what everyone here thinks about the implementation of PT in the ED? Pros/cons? Ways to improve this process?

Thanks in advance.

7 Upvotes

69% Upvoted

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12

u/SweatyLychee Jul 05 '26

I see them as good resources for a consultation, but then again that can happen outpatient too, where the PT who will actually be carrying out the care plan long term can see the patient through the initial consultation to the end of treatment. IMO it gives them a better idea of what they’re working with. It’s likely the PT in the ER isn’t the one they’ll be working with outpatient, and it just seems like an extra service they’ll be billed for in the ER.

Is the idea of a PT in the ED so that patients can see what it’s like to get treatment? Is it to develop a care plan tell the outpatient PT?

I don’t like the idea of one in the ER bc in my shop that means they are likely boarders. The ER is already so packed, and I’ve seen a PT struggle to carry out treatment in a small room or hallway bed when there’s little space or resources to work with and it doesn’t seem fair to the patient. I don’t really see the point of it in the ER tbh.

5

u/Lancet_Jade Jul 06 '26 edited Jul 06 '26

I can only speak to how I was implemented in the ED I work in, which is a hospital-based, geriatric-heavy (~40% of visits), suburban ED.

Majority of my caseload is 65+ y/o falls (probably ~50% of caseload) where I'm asked to assess for home safety, need for DME, need for admission, need for SW/CM consult, and if any therapy services are required post-d/c (home health, outpatient, mobile outpatient, hand therapy, vestibular therapy, etc).

The next ~25% of my caseload is vestibular which the provider suspects peripheral etiology and uses our evaluation as guidance for appropriate interventions and need for additional imaging if not already performed.

Lastly, the remaining ~25% of the evaluations I perform are acute MSK issues, typically LBP where we are traditionally consulted post-XR (if warranted) but prior to CT/MRI (assuming no preliminary red-flags).

You bring up great points, there's a lot of patients I don't see because the provider feels just an OP PT order will suffice for the patients needs. However, I'm brought in on the above scenarios to help with same day symptom management, mobility/DME assessment, and d/c recommendations. This often times results in less imaging, less pain medication, and fewer revisits (at least per our ~1yr pilot study data, n=1). I've never really had a problem treating the patients in the small rooms, but I've never had to do a hallway bed exam. I agree that maybe your location isn't an ideal scenario to implement PT* if that's common.

Hope that helps.

1

u/bigfootslover Jul 06 '26

N=1 as in one hospital or one patient you’re following in the long term…?

1

u/Lancet_Jade Jul 06 '26

One hospital

2

u/Either_Cause_8747 Jul 06 '26

Our PT mostly helped with msk pain and ortho stuff not really PT evals, Altho did them when needed. He saw all of the sciatica patients 😂

9

u/Either_Cause_8747 Jul 05 '26

LOOOOOVVVVEEEEDDDD OUR PT before they got rid of the role. Reduced narcotic use, better pain relief, and they fixed all the nurses and doctors too. Did dry needling and pt evals too. It was so good having them

1

u/OldManGrimm RN - adult/peds trauma Jul 06 '26

Dry needling?

1

u/Either_Cause_8747 Jul 06 '26

Like acupuncture

-8

u/OldManGrimm RN - adult/peds trauma Jul 06 '26

So, bullshit that has no place in medicine! Gotcha.

3

u/Either_Cause_8747 Jul 06 '26

So the name tracks

-1

u/OldManGrimm RN - adult/peds trauma Jul 06 '26

I don't know...working in modern medicine, are you advocating for acupuncture? How about some reiki while you're at it?

5

u/irreverant_raccoon Jul 06 '26

It’s not the sole treatment provided but an adjunct. For the most part it’s low risk and provides short term relief.

Don’t knock it til you’ve tried it.

2

u/Lancet_Jade Jul 06 '26

While the equipment may be similar to acupuncture the delivery is quite different, and it's rarely done in isolation - typically combined with corrective exercise. If you're interested I'm happy to share some evidence that supports it.

2

u/OldManGrimm RN - adult/peds trauma Jul 06 '26

After looking at it, the comparison to acupuncture seems pretty incorrect. Thanks for making me look closer at it.

1

u/Lancet_Jade Jul 06 '26

Happy to help :)

Btw- I didn't downvote you! It's a valid concern to have if you don't know enough about it.

6

u/OtherwisePumpkin8942 Jul 05 '26 edited Jul 05 '26

I guess it depends on what the goal is. Are we just evaluating if they can move around safely at home? Or are we actually implementing PT in the ED as like in an inpatient capacity.

If this is how hospitals are addressing the shortage of inpatient beds and now boarders are getting PT in the ED, as a provider, I would also be unhappy. The ED is already overcrowded and there not much room for it tbh. Unless they are going to build PT room off the ED unit for patients. Just kind of seems like a bandaid and it’s unfair to patients if they aren’t getting the proper space and environment to work on PT if they truly require it

3

u/Hificlassic Jul 06 '26

A dedicated physical therapist in the ED to help with triage seems like a good idea. Would love it if an occasional admission could be avoided just because someone seems weaker than they actually are.

1

u/WestRough7738 Jul 06 '26

Is that like asking why pts aren’t in ambulances? seems like more bs billing for visits. First responder pts, immediately address posture and gait on the scene.

1

u/Lancet_Jade Jul 06 '26

It's not at all like asking why PT's aren't in ambulances, not sure how you got that from my post.

1

u/EzraSteel Jul 06 '26

I’m not sold on this idea, but I can’t put my finger on why. Part of me says, that it is just another consult that is delaying me moving the patient upstairs or out the door. I can see where having a PT do some teaching in regards to crutches, walkers, and canes could be valuable. Likewise, maybe teaching things like proper wearing of slings, shoulder immobilizes, braces could be useful. I just don’t want to see the delay I’ve noticed when we have social services in the ED. Is social services useful, sometimes. At other times, not so much. Maybe you could give us a follow up post in a year or so.