
After graduating from the University of Iowa with her DPT in Dec 2006, Dr. Nechvatal started as a new graduate at St. Mary’s Hospital in Madison, WI. There, she established the ED PT consultation service 2010 and worked there until 2022. She now works at UnityPoint Health Meriter Hospital where I am one of the EPTs and am a per diem therapist at the UW Hospital and American Family Children’s Hospital. In addition to her clinical work, Dr. Nechvatal leads the Innovative Practice Committee with APTA Wisconsin which strives to make early access to PT in all settings the standard in Wisconsin. She is also vice chair on the EPT National Steering Committee.
Describe how you became involved in Emergency Department Physical Therapist Practice.
I had an acute care clinical rotation at St. Joseph Carondelet Hospital in Tucson, AZ during my final year of PT school in 2006. While there, I was fortunate enough to spend a couple of days with Carleen Jogodka, one of the founding EPTs. That experience left me inspired and excited to one day practice in the emergency setting as well which then led to the establishment of the ED PT consultation service at St. Mary’s Hospital.
Describe your practice setting and ED PT model.
Physical therapists are on-call to our Emergency Department 7 days a week from 8:00 am-4:30 pm but we also have blocks of time in the afternoons that we are present in the ED to increase awareness of our availability which tends to increase our referral numbers. The ED is covered by a small group of acute care PTs.

Why do you think this is a valuable practice area?
Physical therapists offer such a wide range of interventions that are non-pharmacological for a variety of acute conditions and therefore we can empower patients to be able to manage their own symptoms. Besides the high quality of care, increased patient satisfaction and increased medical provider satisfaction, there are many financial benefits to having early access to a PT. It’s the right care at the right time and there should not be an emergency department without access to PT.
What was the biggest adjustment for you in practicing in the ED?
The culture and the pace are different in the ED. There have been times when I am assessing a patient and patient transport arrives to take them to radiology for imaging. While in the inpatient setting, the patient transporter may be able to wait a few minutes while I finish my assessment. In the ED, everything is urgent and there is not much room for other disciplines to wait if they have other emergent orders to manage. Along with this pace is the high intensity level of an ED. Witnessing true emergencies when they present to the ED and how the ED staff manages those crises is both startling and admirable.
Do you have an area of specialty?
I refer to myself as an acute care generalist with an emphasis on Emergency PT and ICU PT. Really, I’m a “jack of all PT trades” which has been beneficial in the ED so that I have been able to manage a wide variety of conditions. I was a student athletic trainer in undergrad so working in the ED setting allows me to utilize my skills as a PT but also my think and act quickly skills developed as an athletic trainer.
What barriers did you have to overcome personally and within your facility to practice successfully in this environment?
Surprisingly, most MDs were excited to have us in the ED but nursing staff was concerned at first. They were mostly concerned about how our PT session would prolong their throughput statistics. Since this was an unanticipated concern, we set an expectation that our “call to contact” time would be 20 minutes and our length of session would not exceed 60 minutes. Then we tracked these timeframes along with other data and we were able to demonstrate that not only did we meet our expectations, but we actually decreased throughput for the patients PT was involved with.
What is your philosophy about what makes an ideal ED PT?
Ah yes, the unicorn EPT. The ideal EPT would be a PT who is great at everything because you could see literally anything in the ED. However, since this unicorn does not exist, I would say that since the medical providers look to PTs to aide in their differential diagnosis, it is important to have strong MSK assessment skills, vestibular assessment and treatment skills, neurological assessment skills and most importantly, solid interpersonal skills. The interpersonal skills are vital in reassuring the patient. To be able to listen to the patient, empower and help problem solve are very necessary skills. Interpersonal skills also help develop relationships with ED staff which is also important during the early days of a EPT program.

What was your biggest win in the ED?
There are so few conditions that PT deal with that can be fixed quickly and easily such as a successful Epley maneuver. Dramatic improvement in symptoms after a PT intervention is well worth the celebration for both the patient and the PT and it seems to me that dramatic improvement in symptoms with PT intervention is common in the ED setting. However I would say that my biggest win would be that I was consulted by an MD who never called us as he seemed to be a bit “old school” in his practice.
When he did call…
He had a patient who presented with “20/10” back pain and the MD had tried IV narcotics without improvement of symptoms. He attempted to admit the patient for pain control but the Hospitalist MD insisted that he consult PT before making the decision to admit the patient. Needless to say, the MD begrudgingly consulted PT at that point.
He said “I don’t know what YOU’RE going to do…”
So at that point, not only did I have a patient with severe back pain but I also had to prove our worth to an MD who already did not have faith in PTs value. After I used most of my skills (manual therapy, e-stim, stretching, AAROM, heat, pain education and joint mobs) the patient started to feel some pain relief and asked to go to the bathroom. On the way there, I made sure we walked right by the MD’s window so that I could knock on it, wave and give a thumbs up as the patient and I walked by. Of course, the patient’s relief was the most satisfying and I was able to discharge the patient home with outpatient PT follow-up. Seeing the MD’s jaw drop as we walked by was pretty satisfying too.
To Learn More
To hear more about Dr. Nechvatal’s practice and why direct access is meaningless without early access, listen to our podcast or watch the vlogcast. To get involved in the discussions around early access, click here. Read more about different ED PT models here.
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