Physiotherapy in the Emergency Department in Australia

Meet Marie K. March, BAppSc(Phty), Senior Physiotherapist, Clinical Lecturer and PhD candidate. She is a physiotherapist practicing in an Emergency Department in Australia.

Describe how you became involved in Emergency Department Physical Therapist Practice.

I have a broad range of experience across inpatients and outpatient hospital services, with a focus on orthopaedics (elective surgery, orthopaedic trauma, fracture clinic).

At my hospital we have had a musculoskeletal primary care physiotherapy service for over ten years. In 2019 our hospital launched a position on this team that started my involvement. I am now increasing my involvement in the primary care aspects as they arise.

Describe your practice setting and ED PT model.

Our setting is a metropolitan hospital serving a culturally diverse population, with well over 100 languages spoken across our broader district. Our community is rapidly growing, and we also serve many people and families experiencing social disadvantage.

Our emergency department has over 20 acute beds, up to 12 pediatric beds, a handful of RESUS beds, an ED short stay and an urgent care section.

Our ED PT model is part of a new allied health service embedded in the emergency department, including physiotherapy, occupational therapy and social work. We provide a seven day extended hours service, which is largely secondary care. We have embraced a transdisciplinary model of care, in particular across PT and OT, so if only one discipline is available, we can work within a broad scope and provide efficient, patient-centred care with one staff member.

Why do you think this is a valuable practice area?

Patients, families and carers are benefiting from a higher quality of care that addresses patient needs holistically, and means they are less likely to re-present to ED. They also have a better patient experience while in the ED, which is a place of heightened stress for everyone.

The physiotherapy profession benefits as we are demonstrating our skills in a new context, and extending our scope of practice, in both a discharge planning area and primary musculoskeletal care.

The emergency department clinical staff have welcomed us with open arms, as we are able to provide expert opinions that can influence decisions on admission and discharge.

The health services also benefit as we have a huge impact on important key performance measures.

What was the biggest adjustment for you in practicing in the ED?

The physical environment was the hardest adjustment for me. It is a crowded, noisy place with patients and carers who may be in acute distress, overhead announcements, and emergency buzzers.

We also find ourselves being asked random questions, cups of tea, directions, and the like. Being aware of patients who are acutely confused or at risk of absconding is also important.

Do you have an area of specialty?

One of the best things about my role is the breadth of scope and having to do everything, and I am much more aware of my weaknesses! The two main strengths I bring are complex discharge planning from the ED, and fracture management.



Although it’s not a speciality, having exposure to psychologically-informed physiotherapy practice through my PhD, I bring elements of this approach to the ED perhaps more than my colleagues.

What barriers did you have to overcome personally and within your facility to practice successfully in this environment? 

As we established our new service, we were constantly evaluating our timing and rosters. Initially we trialed a 10:30 pm shift finish time which had big impacts on sleeping, eating and family life. Now this has changed so that the latest finish is 8:30 pm which is much better.

We were fortunate have sufficient funding and executive level sponsorship which ensured this model was established in a sustainable way. However, this has not been the experience everywhere.

I had to reframe some elements of my practice particularly around clinical risk management, and the scope of what can/should be done in ED, learning to be content with uncertainty.

What is your philosophy about what makes an ideal ED PT?

A flexible, calm PT with good insight into their weaknesses who is a continual learner and a strong communicator is where I would start. Foundational skills and experience in musculoskeletal care and geriatric discharge planning are the main ‘on paper’ requirements.

What was your biggest win in the ED?

Two particularly complex discharges come to mind, who had limited weight bearing due to fractures with chronic neurological impairments. The other clinical scenario involved advocating for admission for a patient who ended up having seizures overnight. As we were  newly establishing a service I think some of our wins are signs that we are embedded as part of the team- coffee rounds and Christmas party invitations are very small indicators but they are important.

What are some differences between US and Australian Practice in the ED?

I think the main differences is around funding.

In Australia, once a patient is triaged, they are seen by the best person at that time, which might be a medical doctor, a nurse practitioner, a primary care physiotherapist. We have a universal healthcare system, and so patients are generally not paying “per service,” so we can initiate involvement as we see fit without patients paying more. Physiotherapists also have authority to prescribe our interventions such as ongoing outpatient therapy, walking aids, taping or bracing, for example. We arrange it with the patient and let our treating ED doctors know as a courtesy. There are small out of pocket costs for equipment/bracing but these are generally under $50-100.

What are some differences in practice in across Australia?

Different states and hospitals have pioneered advanced scope physiotherapy and ED practice at different speeds. There is also a wide range of uptake across metropolitan compared to regional and rural areas. The model of having both primary and secondary care physiotherapy in ED was established as much as 10-15 years ago in other centres, whereas there are some hospitals who don’t have any ED PT at all. In some places, ED physiotherapy may be embedded into a aged care service, limiting their scope of practice to these clients.

In Australia we have national, general registration, which does not include specialization. However, there are states differences in terms of expectation- in some areas, the first level of senior staff are expected to doing or have completed a post-qualification Masters degree. Yet in other places, there is little incentive or expectation for this. 

For More

Listen or watch our full interview. Connect with Marie.