Catherine Knight1, Dr Fiona Fenton1, Adrienne Fosang1, Michelle McCarthy1, Dr Peter Barnett1, Dr Kelly Weir1,2
1The Royal Children's Hospital, Parkville, Australia, 2The University of Melbourne, Parkville, Australia
Biography:
Catherine Knight is a physiotherapist with a Master’s degree in Musculoskeletal Physiotherapy. Following an early career in hospitals and private practice, she has since established a career working in an advanced practice physiotherapy capacity as a clinician in Emergency Department and Virtual Fracture Clinic services, establishing and evaluating new models of care, educating post-graduate students, and leading a team of other advanced practice physiotherapists. Catherine is passionate about allied health professionals having the opportunity to work at the top of scope of practice, and delivering best care to patients.
Abstract:
Background:
Increasing demand for Emergency Department (ED) services challenges healthcare systems to provide care to patients in clinically appropriate time frames. To meet demand, alternative models of care (MOC) and initiatives to divert patients to alternate healthcare providers have been implemented. Musculoskeletal injury comprises a substantial proportion of ED presentations, and provides the rationale for including advanced practice physiotherapists (APP) in the team of ED treating clinicians. To date, APP roles have not been evaluated in a paediatric-only Australian ED context.
Method:
Our tertiary paediatric hospital undertook a 12-month project implementing an APP MOC in the ED, managing predominantly lower acuity musculoskeletal conditions. Patient demographic, clinical activity data, and patient/staff satisfaction data were collected and compared with a similar patient cohort for the preceding 12 months.
Results:
An APP provided care to 735 patients over 10 months. Data analysis identified a shorter median wait time (14 vs 22 mins) and median length of stay (121 vs 185 mins) for ED-APP patients compared with baseline. The ED-APP MOC achieved all wait time targets across relevant triage categories. Compliance with transfer/discharge target of <4 hours was consistently higher in the ED-APP cohort. Unplanned re-presentation rates in <48 hours were low (<1.5%). There was excellent patient/carer satisfaction.
Discussion:
This project demonstrates that an APP MOC can provide safe, timely and effective care of paediatric patients with musculoskeletal conditions in the ED setting. This has implications for other health services seeking to implement new MOCs to respond to increasing service demands.