Physiotherapists in the emergency room

At a time when emergencies are overflowing for lack of personnel, one solution could be to employ…physiotherapists there. Their presence on the front line in hospitals improves patient care and relieves congestion in services, according to a study carried out at the CHU de Québec.

Lila Dussault
The Press

Quebec’s emergency room occupancy rate reached 117% on August 10, up from the previous ten days, according to Index Santé’s Quebec emergency room occupancy rate index.

One way to unclog them would be to increase the presence of physiotherapists in emergency rooms — there have been some at the CHU de Québec since 2020. The presence of physiotherapists improves the care of patients with mild musculoskeletal problems, while relieving emergency physicians, says Simon Dalle-Vedove, president of the Quebec Association of Physiotherapy (AQP).

“The expertise of the emergency physician can be used for priority cases,” he explains. And we physiotherapists can help with less urgent cases, which is really our strength. »

In the province, nearly 25% of emergency room visits are related to mild musculoskeletal problems, such as sprains, falls and possible fractures, according to the AQP.

The Ministry of Health and Social Services (MSSS) is considering the implementation on a larger scale of physiotherapists in the emergency rooms of the province, indicates Mr. Dalle-Vedove. “But with the situation in the emergency room at the moment, we think that maybe it could go faster. »

The MSSS confirms that there are currently “a few pilot projects for the integration of physiotherapists offering a physiotherapy service with direct access to the emergency room”.

However, the Ministry wants to wait for the results of the pilot projects before extending the practice. “The results will make it possible to further explore the advantages of this new model of care as well as the possibilities of deployment in other centres,” said Robert Maranda, media relations officer for the MSSS, by email. However, it is too early to draw conclusions or make conclusions. »

In the capital, a pilot project carried out in 2018 has had fairly conclusive results for the deployment of physiotherapists in emergencies to take place from 2020.

A meeting on this subject between the APQ and a political adviser from the office of the Minister of Health and Social Services, Christian Dubé, is scheduled for next Tuesday.

Less waiting, more satisfaction

Physiotherapists can see patients without being referred by a doctor, as they already do in private practice. In the emergency room, they can therefore independently assess and manage patients previously seen in triage — and who suffer from a problem affecting their field of expertise.

According to several studies conducted in Quebec and elsewhere—particularly in Australia and the United Kingdom, where this practice is already in place—this method of proceeding reduces the waiting time for patients, their pain, their medication intake and the rate repeated consultations for the same problem.

For example, according to a study conducted by Laval University in 2018 and 2019, patients cared for by physiotherapists in the emergency room of the CHU de Québec waited three hours less than the others, i.e. approximately two hours of waiting instead of five, indicates the AQP.

In addition, their clinical condition had improved compared to the other patients. There were no new emergency department visits for the same problem in the month following the first consultation, compared to 21% of new visits in the group not managed by the physiotherapist.

Ready to come as reinforcements

The AQP conducted a survey of its members last spring to find out if they wanted to work in emergencies. Of 308 respondents, 271 responded positively.

“The vast majority of respondents answered that a position in the emergency department interested them,” explains Mr. Dalle-Vedove. And everywhere in the province! That was really impressive. »

A shortage of physiotherapists is not to be feared, according to him. “In the active practice of physiotherapy, having positions at this level, with additional responsibilities [comme aux urgences], it’s very attractive, he says. It’s sure to attract people. »

Even without government support, several hospitals are already trying to move forward with this approach, says Mr. Dalle-Vedove. “There are very committed physiotherapists who take the lead in the hospitals where they work, but here, I think that at the MSSS level, we have to take action. »

A reassuring presence

For the first time in Canada, the Montreal Children’s Hospital (MCH) conducted a study on the presence of physiotherapists in pediatric emergency rooms. Results: faster care for young patients and greater satisfaction for parents.

From November 2021 to last June, physiotherapists at the Montreal Children’s Hospital met with young patients in the emergency room three afternoons a week. They initially focused on assessing concussions before broadening their consultations, towards the end of the pilot project, to other mild musculoskeletal problems (rating 3, 4 or 5 in terms of severity). Of the 1006 patients seen in the emergency room and presenting the problem targeted by the research, the physiotherapists met 78, explains Isabelle Gagnon, physiotherapist-researcher at HME-MUHC and head of the study.

Positive preliminary results

“I found that it was really interesting and that, for the parents and the children, it was reassuring to be seen earlier,” testifies Lina Osseiran, physiotherapist met in the emergency room of the MCH. “It’s stressful, for example, to arrive with a baby who has fallen out of bed. As a parent, we feel bad. »

The preliminary results of the study seem to confirm these benefits. Compared to patients seen in the same hours by regular emergency teams, those seen by a physiotherapist had “better satisfaction”, explains Ms.^me Gagnon. “It was about the inclusion of people, the time given to the patient, the time given to ask questions, etc. »

This is the case of Rose, a 14-year-old teenager met at the Children’s after she passed out and hit her head. Before seeing a doctor, she had a full evaluation with Mr.^me Osseiran. Her case ultimately seemed benign, but “if she had really hit her head hard, I would have thought it positive that she was seen immediately. [par la physiothérapeute] “, observed his mother, Annie Marcil.

Orient faster, with more information

Another positive effect noted during the pilot project: the evaluation of the physiotherapists allowed a better transfer of documentation between the hospital teams, if the patient required follow-up for a concussion, for example. “Obviously, when the physiotherapist was there, we had the information 100% of the time, compared to 30% when there was no physiotherapist,” explains Ms.^me Gagnon.

Finally, young patients were also referred more quickly to follow-up programs. “There was less ‘we’ll wait and see,'” she says, because the diagnosis was more accurate. “Children [qui en avaient besoin] were referred the same day and had a follow-up within a week. »

In search of funding, the team of M^me Gagnon hopes to be able to resume the study in the fall, with physiotherapists present in the emergency room 7 days a week.