Meet Dr. Kyle Knauff
Dr. Knauff is an Emergency Department Physical Therapist at UnityPoint Meriter Hospital in Madison, WI. He is a 2006 graduate of Marquette University and became an Orthopedic Certified Specialist in 2012. He has been working for Meriter in their Emergency Department since 2017.
Describe how you became involved in Emergency Department Physical Therapist Practice.
I worked in outpatient PT for 10 years, before making the switch to Acute Care. There was another PT that was already starting our program, so I decided to tag along with her to get it started. It was just a natural fit with my outpatient experience.
Describe your practice setting and ED PT model.
We have a 31 bed Emergency Department with 3 to 4 physicians/ APPs on at a time. We are floating between the acute care floor and the ED, but generally spend at least half of the day within the ED.
Why do you think this is a valuable practice area?
The providers always mention about how much of a patient satisfier we are. We are able to offer a different pain perspective and give patients a path to help themselves when they leave our ED. During the pandemic, it has been vitally important to keep patients out of the hospital. Our triage skills have helped manage the flow of patients admitted.
What was the biggest adjustment for you in practicing in the ED?
Personally, my biggest adjustment was a change in mindset. In outpatient, my focus was improving patient’ pain experiences immediately to build a relationship moving forward. In the ED, my focus is to improve patients’ pain experiences to give them a path forward and guide them to outpatient. I’m making sure they are safe to return home, but not necessarily improving their pain experience to a 0, like I would shoot for in outpatient.
Do you have an area of specialty?
I’m an Orthopedic Certified Specialist. In outpatient, I loved working with overhead athletes and general foot/ ankle mechanics. I don’t get to do that as much anymore, but I still use those skills within the ED.
What barriers did you have to overcome personally and within your facility to practice successfully in this environment?
Personally, coming from outpatient, I felt I needed to be busy all of the time. When we first started, it was lots of standing/ waiting, which was difficult for me. As our program has grown, that has become less and less. Our facility has been great and has always supported us, from our management to the ED providers. I couldn’t have asked for a better situation.
What is your philosophy about what makes an ideal ED PT?
Philosophy changes on how old your program is. At the beginning, you need some go getters (shout out to Alaina Davis and Hannah Kevern, our PTs when we started), who will “sell” the providers on our services. At the same time, you have to have the ability to read the room. Bothering the providers, while they are managing traumas or strokes, might not be ideal when you are just getting off the ground. As your program grows, you really have to have individuals who will champion the program (again shout outs to Beth Vandervest and Nathan Smith, our current PTs besides myself). To be effective, you have to give a lot of yourself and your time, including staying late, working through lunch, etc… Otherwise, you have to have some skills in vestibular, outpatient ortho and probably most important, doing a good fall risk assessment.
What was your biggest win in the ED?
On Christmas Eve one year, I was just about to finish my shift when one of our nurses saw me and said they might need me to see a patient. I walked over to the provider and asked what he thought. He told me it was Christmas Eve and to leave. I emphasized that I could, it wasn’t a big deal. The patient had an orthopedic problem and wanted to make sure nothing was broken. As I talked to them, they noted that they had 20 people coming over the next day for Christmas Day and they were not staying. Plain films were negative, so I got the patient a walker, did a gait assessment and they discharged home. I left 45 minutes late. The provider was happy that the patient got the best care possible. The nursing staff was happy that I was there to do the gait assessment and provide a walker. The patient was happy that nothing was broken and they got an assistive device to help with their mobility. I was happy to provide a valuable service to our team and our community and really show what a Physical Therapist can do for someone on a Christmas Eve evening.
For More Pearls From Dr. Knauff
Dr. Knauff & Dr. Griffith lead a journal club discussion for PTJ about Emergency Department Physical Therapist Practice here. Listen or watch our full interview. Interested in learning more about the on-call PT model in the ED? Read more here.