A novel model of advanced physiotherapy practice: Diverting patients from the emergency department directly to an outpatient clinic
Piers Truter1,2, Pippa Flanagan1,3, Luke Bongiascia4, Alison Vaughan5, Tim Leen1 1South Metropolitan Health Service, Murdoch, WA, Australia2University of Notre Dame, Australia, Fremantle, WA, Australia3Curtin University of Technology, Bentley, WA, Australia4Rockingham General Hospital, Physiotherapy Deparment, Rockingham, WA, Australia5Western Australia Department of Health, East Perth , WA, Australia
Abstract
Background: The WA Department of Health (DoH) funded a pilot to divert patients with musculoskeletal conditions directly from the emergency department (ED) to a novel outpatient physiotherapy clinic. The clinic is staffed by advanced scope physiotherapists (ASP), supported by senior physiotherapists with outpatient and ED experience. Typical physiotherapy patients as well as fractures (including plastering and thermoplastic splinting) are managed.
Method: Patients aged 8-65 were diverted from February 2022. A REDCap database captures clinical encounter data, tracks return to ED and surveys patients for clinical outcomes and satisfaction. The clinic was piloted by experienced ED ASPs, but after recruitment and training, transitioned to running with clinicians primarily recruited from existing hospital senior staff.
Results: Over 1,500 patients have been diverted to outpatients. Most diverted patient are Australasian triage category 4 (74%), have an average length of ED stay of 75 mins and 98% are satisfied with the care they receive. The clinic connected 71% of patients to ongoing care in orthopaedics, hand surgery or physiotherapy outpatients. Only 1% of patients returned to the ED, as 9% of patients self-initiated follow up care in the clinic. Most additional acute care continuity was by TeleHealth. Independent WA DoH, Health economic analysis demonstrated that this clinic was the dominant treatment model when compared to usual care in the ED.
Discussion: The South Metropolitan Health Service ED musculoskeletal diversion clinic has been permanently funded at Rockingham Hospital because it significantly reduces crowding in the emergency department, provides excellent care and is cost effective.
Biography
Piers is an advanced scope physiotherapy (ASP) in FSH Orthopaedics and the FSH and RGH Emergency Department (ED). He has worked beyond his clinical roles as a health system innovator since 2016. He set up the SJOG Midland Hospital ED ASP service in 2016 and helped pilot the Gold Coast University Hospital ED ASP service in 2017.
With support from the SMHS Innovation team he developed a physiotherapy lead ‘Virtual Fracture Clinic’ (orthopaedic TeleHealth fracture care) in 2020 and was awarded a Department of Health grant to divert patients from the Emergency Department to hospital physiotherapy outpatients in 2021.