Meet Taylor Bush PT, DPT – NAU DPT Class of 2021!
Describe how you became involved in Emergency Department Physical Therapist Practice.
I first heard about PT in the ED from Jon Davison when I was a PT tech for him in 2013. He was actually part of the team in Tucson that helped establish this as a field of practice for us over 20 years ago! It intrigued me then and after learning more about it in PT school, I knew I wanted to pursue a rotation in this setting. I was lucky enough to do my last clinical rotation in the emergency department at Flagstaff Medical Center and they ended up offering me a job when I graduated.
Describe your practice setting and ED PT model.
Our emergency department employs a full time PT, 7 days a week. We are housed in the ED and see patients from 11 am to 730 pm. There are 35 beds, 3 devoted to traumas, and 4-6 that are used as our “fast track” area. The fast track is meant for lower acuity patients and is staffed with an physician, a nurse, an ED tech, and us! We literally sit right next to the doctor and get many of our consults from the fast track area.
Why do you think this is a valuable practice area?
There are so many facets to a PT’s value in this setting. Imagine you hurt your knee while hiking and head to the ED to get it checked out. You will likely receive an x-ray if the doctor feels it is necessary and if there is no fracture or dislocation, the treatment is often limited to an ace wrap, crutches, and pain meds as needed. With a PT there, we are evaluating you for any soft tissue injury and your ability to mobilize safely. We can not only identify the structure that may be affected but we begin treating it right then and there! We then give you things to do at home until you are able to follow up with an outpatient PT clinic for further care. All this to say that we begin treating the issue immediately so there is no delay in care and assist with appropriate follow up so you get back to doing what you love to do, sooner!
Another aspect of our value is reduced healthcare costs. PT’s in the ED minimize the need for unnecessary imaging, reduce unnecessary admissions to the hospital, and reduce returns to the ED for non-emergent injuries.
Lastly, many individuals don’t have health insurance, let alone the means to afford outpatient physical therapy services or wound care. By staffing the ED with a PT, these individuals now have access to our skill set and knowledge and can have some assistance in managing their injuries and wounds appropriately.
What was the biggest adjustment for you in practicing in the ED?
The diversity of diagnoses that we see was a large adjustment. It’s never just musculoskeletal injuries! A day can include gait evaluations, neurological screening, managing BPPV, wound care, and splinting a fracture. The variability and walking into the unknown every day is challenging but it is truly my favorite part of working in this setting.
Do you have an area of specialty?
I don’t have any certified specialty, but I really enjoy treating lower extremity injuries. When I get a consult for knee pain, I walk into the room feeling very confident in my abilities.
What barriers did you have to overcome personally and within your facility to practice successfully in this environment?
Personally, as a new grad, this setting can be very intimidating. I really had to learn to trust my knowledge as a PT and speak up for my patients and myself when I believe their plan of care needs to be something different than what the doctor originally suggests. Luckily for me, Dr. Lisa TenBarge has been working in this department for 16 years and has demonstrated the incredible value and skill set of physical therapists. So all of our doctors truly value our input and opinions and it has been such a lovely experience working with them.
What is your philosophy about what makes an ideal ED PT?
I believe an ideal ED PT is someone who has solid evaluation skills, is pragmatic, and embraces the chaos. But truly, the things that make a great PT in any setting, make a great PT in the ED. Kindness, a continued desire to learn and evolve, and great communication skills will get you far!
What was your biggest win in the ED?
A woman with thigh and hip pain came into the ED and a PT consult was placed. An x-ray of her pelvis and hip had been performed and was negative for any fracture or abnormality. When I evaluated her it appeared as though her pain was actually coming from her lower back. Once we determined that, we were able to improve her symptoms on the treatment table, but as soon as we tried to stand her severe thigh pain came back immediately. Warning signs were going off in my head so I told the physician that she may be appropriate for a CT scan of the lumbar spine. Thankfully, the MD ordered that imaging and it revealed a mass in her spine from L1-L2. She was admitted for further workup and treatment. This was a huge win for me as a new grad, because I trusted my exam and my gut feeling that something more was going on and it helped the patient to find some answers!
What questions do you have for Dr. Taylor Bush, an early career PT working in the ED?