Are physical therapists working with you in the ED?

[Elbrus]

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This is part of a larger survey, but I will keep it limited to one question here with numerous choices - read to the bottom if you don't have a PT working with you.
Commentary or feedback on questions is welcome.

 

[Tiger26]

We have them during regular business hours--very helpful with back pain, falls assessments in the elderly, and occasionally vertigo

 

[Mount Asclepius]

PT comes to our EDs from upstairs only to consult/perform evals to assist CM with facility placement or HHC recommendations.

 

[Elbrus]

We have them during regular business hours--very helpful with back pain, falls assessments in the elderly, and occasionally vertigo

Do you find that business coverage hours are adequate? If not, what coverage hours would you like to see staffed?

 

[Janders]

The vast majority of our PT usage is for elderly home safety, falls with minor injury, possible placement to acute rehab. During bankers hours.

 

[WhatJobDoIPick]

One of the major functions of my ED is as a dumping ground for families who don't want to take care of their loved ones.

PT helps us justify spending Medicaid dollars for placement.

 

[RustedFox]

Where TF do you guys all work?

A physical therapist... In the ER?

Eff outta here .

 

[JacobMcCandles]

We can occasionally get a PT eval if it’s a weekday and the patient is a social drop off first thing in the morning that needs placement. Other than that, ain’t happening.

 

[pkwraith]

Do PT really want to be consulted for suspected drug-seeeking?

 

[Tiger26]

Do you find that business coverage hours are adequate? If not, what coverage hours would you like to see staffed?

Yeah seems adequate--the type of people who come in for back pain at night are often not the type who'd actually do any of the exercises a PT would show them.

Small revision to my initial response--we have access to them during the day, but they come from the medical floor, albiet fairly promptly

 

[Janders]

We got aggressive with some of the ACA, waiver programs, controlled spend, capitated systems and other novel entities in the preCOVID and early COVID time period.

By which I mean, we had methods to get old people into acute rehab from the ED in one business day with great success!

It actually made you feel like a good doctor. Some weak / falling nana would come in. You’d do your med trauma evaluation and find not much acute. But you’d talk to her and family and hear the issues. We had a pharmacy tech who would do a med rec for you (crazy polypharm sometimes!). Instead of discharging to doom or trying to make a “social admit” we’d drop them in ED obsv overnight, and first thing at 0800 PT, case management, SW and occasionally others would all assess the patient— and more importantly have the big talks with the family.

And a bunch we’d place to acute rehab. Some we’d send home with services. Some would just go home.

But it felt like you were doing good for people, and boy did patients / families like it. It also wasn’t much work from the Ed Md side, all the tough work was done by others.

But all the waiver programs have evaporated, everyone needs multiple inpatient midnights to qualify, hospital budgets have gutted PT/CM resources and we are so saturated with boarding we don’t have room to do this.

Sad.

 

[gutonc]

But it felt like you were doing good for people, and boy did patients / families like it. It also wasn’t much work from the Ed Md side, all the tough work was done by others.

But all the waiver programs have evaporated, everyone needs multiple inpatient midnights to qualify, hospital budgets have gutted PT/CM resources and we are so saturated with boarding we don’t have room to do this.

Sad.

And this is only going to get worse now.

I'm not in EM but I'm in a rural CAH with lots of very low SES folks with limited/no resources and lots of medical issues. CM and CHW do so much great work that keeps people out of the hospital and able to be managed well in the OP setting here that it's kind of unbelievable. I'm terrified that those resources are going to get gutted and we'll have a 25 bed hospital full of rocks that aren't ready to die but can't go home because those resources are gone.

 

[TooMuchResearch]

Where TF do you guys all work?

A physical therapist... In the ER?

Eff outta here .

Allegedly I can at one site but I've never seen it happen. I have a rural site I can sometimes discharge direct to the same building PT for vestibular therapy but they don't do ED.

 

[Elbrus]

Do PT really want to be consulted for suspected drug-seeeking?

PTs have mixed feelings about these consults.

Sometimes we notice things like unusual movement patterns or a history that does not quite add up, even uncovering bad pathology. How a patient responds to the idea of PT can also be telling. Some (patients) walk out, some are pleased. Word gets out, PT can be a deterrent for seeking.

From PT side, it can be exhausting if that is the only condition consulted unless it is their jam. If the PT is not accustomed to emergency practice, and/or not trained or interested in a spicy blend of chronic pain and psych/soc issues. You will know based on their eagerness of PT to dig in and help.

 

[xaelia]

Caveat: New Zealand

We have both PT and OT that hit our obs unit in the AM. The night team usually stashes elderly folks who seem unsafe/frail/alone in obs for daylight to reveal the True Nature of the problem. About 20% get admitted for a combination of delayed diagnosis of medical issues or inability to discharge despite supports.

During the rest of daylight hours, our OT covers the rest of the hospital, but also does concussion assessments to hook them up with outpatient rehab. Then, our PT does the same sort of mobilization supports during the day (after hip relocation, etc.), but can also actually see patients primarily for pure MSK stuff in fast track. They always chat with the attending in fast track before/after, but it's still nice when they have time and a simple patient shows up.

 

[bravotwozero]

Where TF do you guys all work?

A physical therapist... In the ER?

Eff outta here .

Yeah, this was my reaction. We can't even get case managers down here, let alone PT/OT. Where are these mythical hospitals

 

[Janders]

Caveat: New Zealand

We have both PT and OT that hit our obs unit in the AM. The night team usually stashes elderly folks who seem unsafe/frail/alone in obs for daylight to reveal the True Nature of the problem. About 20% get admitted for a combination of delayed diagnosis of medical issues or inability to discharge despite supports.

During the rest of daylight hours, our OT covers the rest of the hospital, but also does concussion assessments to hook them up with outpatient rehab. Then, our PT does the same sort of mobilization supports during the day (after hip relocation, etc.), but can also actually see patients primarily for pure MSK stuff in fast track. They always chat with the attending in fast track before/after, but it's still nice when they have time and a simple patient shows up.

This sounds vaguely utopian.

 

[xaelia]

This sounds vaguely utopian.

The austerity government currently in control is doing its best to cut the health service, but we muddle on in hopes of better days.

 

[old_boy]

One of the major functions of my ED is as a dumping ground for families who don't want to take care of their loved ones.

PT helps us justify spending Medicaid dollars for placement.

This