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== Description ==
== Description ==
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In recent years, physiotherapists have been placed in accident and emergency (A&E) departments to improve patient care, free up hospital beds by preventing unnecessary admissions and target optimal functioning of attendees. Emergency department physiotherapy is incorporated in the umbrella of an extended scope of practice. Clinicians in this area display a considerable depth of academic knowledge, clinical skills and experience and may be involved in providing interventions traditionally beyond the physiotherapy scope of practice <ref name="Anaf and Sheppard 2007">ANAF, S,. and SHEPPARD, L.A., 2007. Physiotherapy as a clinical service in emergency departments: a narrative review. Physiotherapy [online]. December, vol. 93, no. 4, pp. 243-252 [viewed 22 October 2015]. Available at: http://ac.els-cdn.com/S0031940607000843/1-s2.0-S0031940607000843-main.pdf?_tid=a9eefaae-7890-11e5-b044-00000aab0f26&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;acdnat=1445500022_313db26b9aac20c5ffddeb231a126484</ref>. In addition to frontline emergency physiotherapy practitioners (EPPs), increasingly physiotherapists are being made part of the integrated multidisciplinary team working in A&E and on medical assessment units . In Scotland for instance, such teams are seen at the Borders General Hospital where the Rapid Assessment and Discharge (RAD) team are heavily involved in early patient contact, and the Integrated Assessment Team at the Victoria Hospital in Fife who carry out a falls assessment on every patient over the age of 64 attending A&E and assist with safe discharge <ref name="NHS Fife 2015">NHS FIFE, 2015. Report to Fife Acute Services Divisional Committee. [viewed 20 October 2015]. Available at: http://publications.1fife.org.uk/weborgs/nhs/uploadfiles/publications/c64_Item14ADNSReport240914(2).pdf</ref>. It is recommended that 80% of patients attending A&E not staying in to be admitted should have length of stay less than 240 minutes <ref name="Taylor et al. 2011">TAYLOR, N.F., NORMAN, E., RODDY, L., TANG, C., PAGRAM, A., and HEARN, K., 2011. Primary contact physiotherapy on emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial. Physiotherapy [online]. vol. 97, no.2, pp. 107-114 [viewed 21 October 2015]. Available at: http://www.sciencedirect.com/science/article/pii/S0031940610001082</ref> .
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In recent years, physiotherapists have been placed in accident and emergency (A&E) departments to improve patient care, free up hospital beds by preventing unnecessary admissions and target optimal functioning of attendees. Emergency department physiotherapy is incorporated in the umbrella of an extended scope of practice. Clinicians in this area display a considerable depth of academic knowledge, clinical skills and experience and may be involved in providing interventions traditionally beyond the physiotherapy scope of practice <ref name="Anaf and Sheppard 2007">ANAF, S,. and SHEPPARD, L.A., 2007. Physiotherapy as a clinical service in emergency departments: a narrative review. Physiotherapy [online]. December, vol. 93, no. 4, pp. 243-252 [viewed 22 October 2015]. Available at: http://ac.els-cdn.com/S0031940607000843/1-s2.0-S0031940607000843-main.pdf?_tid=a9eefaae-7890-11e5-b044-00000aab0f26&
amp;amp;amp;amp;
amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;acdnat=1445500022_313db26b9aac20c5ffddeb231a126484</ref>. In addition to frontline emergency physiotherapy practitioners (EPPs), increasingly physiotherapists are being made part of the integrated multidisciplinary team working in A&E and on medical assessment units . In Scotland for instance, such teams are seen at the Borders General Hospital where the Rapid Assessment and Discharge (RAD) team are heavily involved in early patient contact, and the Integrated Assessment Team at the Victoria Hospital in Fife who carry out a falls assessment on every patient over the age of 64 attending A&E and assist with safe discharge <ref name="NHS Fife 2015">NHS FIFE, 2015. Report to Fife Acute Services Divisional Committee. [viewed 20 October 2015]. Available at: http://publications.1fife.org.uk/weborgs/nhs/uploadfiles/publications/c64_Item14ADNSReport240914(2).pdf</ref>. It is recommended that 80% of patients attending A&E not staying in to be admitted should have length of stay less than 240 minutes <ref name="Taylor et al. 2011">TAYLOR, N.F., NORMAN, E., RODDY, L., TANG, C., PAGRAM, A., and HEARN, K., 2011. Primary contact physiotherapy on emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial. Physiotherapy [online]. vol. 97, no.2, pp. 107-114 [viewed 21 October 2015]. Available at: http://www.sciencedirect.com/science/article/pii/S0031940610001082</ref> .
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One of our student editors also has placement experience with the RAD team at the Borders general Hospital. She reports:
One of our student editors also has placement experience with the RAD team at the Borders general Hospital. She reports:
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'''''“The Rad team which was still being piloted at the time of my placement was made up of one band 6 physiotherapist, one occupational therapist and a further senior physiotherapist (Band 7) with a dual physiotherapy and social care role. Although I was only there for a short period, it was clear the positive effects this set up was having on acute care and I really enjoyed being part of something current and emerging. Throughout the day, patients presenting at A&E requiring physio input were usually seen immediately in the department however if they presented out of clinical hours (8am-7pm) the team aimed to see appropriate patients within 12 hours. If the patient had been admitted, this would usually occur in the Medical Assessment Unit or if they were safe for discharge they would be contacted via telephone within the same timeframe. This allowed decisions regarding home assessments and community visits to be made. The set up of the team enabled interdisciplinary assessments of mobility and functional ability e.g. stairs and self-care to occur, providing patients with the appropriate resources and equipment to ensure a safe discharge and reduce chances of future re-admission. In A&E the majority of the patient’s we saw had newly acquired walking aids so time was spent teaching their use and working with the patient to ensure they were able to function optimally and safely in their home environment. We also saw patients who had long term conditions that unrelated MSK problems were now making harder to manage.'''''
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'''''“The Rad team which was still being piloted at the time of my placement was made up of one band 6 physiotherapist, one occupational therapist and a further senior physiotherapist (Band 7) with a dual physiotherapy and social care role. Although I was only there for a short period, it was clear the positive effects this set up was having on acute care and I really enjoyed being part of something current and emerging. Throughout the day, patients presenting at A&E requiring physio input were usually seen immediately in the department however if they presented out of clinical hours (8am-7pm) the team aimed to see appropriate patients within 12 hours. If the patient had been admitted, this would usually occur in the Medical Assessment Unit or if they were safe for discharge they would be contacted via telephone within the same timeframe. This allowed decisions regarding home assessments and community visits to be made. The set up of the team enabled interdisciplinary assessments of mobility and functional ability e.g. stairs and self-care to occur, providing patients with the appropriate resources and equipment to ensure a safe discharge and reduce chances of future re-admission. In A&E the majority of the patient’s we saw had newly acquired walking aids so time was spent teaching their use and working with the patient to ensure they were able to function optimally and safely in their home environment. We also saw patients who had long term conditions that unrelated MSK problems were now making harder to manage.
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'''''One of my favourite aspects of the placement was the day to day variation. One day could be spent in MAU, preparing patients for discharge without any requirement for the team in A&E while other days could be spent solely in A&E or out on home-visits without a hospital ward in sight. I thrived on this anticipatory element and the experience highlighted to me how the profession is changing as we try to move care out into the community. I was aware however of some challenges facing the team. Due to being a pilot the team was still establishing itself across the hospitals, with better knowledge of its purpose in some areas and some professionals than others. This also meant that here was also no set protocol as to when RAD input was sourced and different methods of triage were being tried and tested over the course of my placement. The end of my time with them saw the prospect of the RAD team being based in the A&E department to increase awareness of the teams purpose and to avoid relying on appropriate referrals being made. I did not have any doubt that with a bit of perseverance this would happen and the RAD team in time would become much better established at the hospital.”'''''
'''''One of my favourite aspects of the placement was the day to day variation. One day could be spent in MAU, preparing patients for discharge without any requirement for the team in A&E while other days could be spent solely in A&E or out on home-visits without a hospital ward in sight. I thrived on this anticipatory element and the experience highlighted to me how the profession is changing as we try to move care out into the community. I was aware however of some challenges facing the team. Due to being a pilot the team was still establishing itself across the hospitals, with better knowledge of its purpose in some areas and some professionals than others. This also meant that here was also no set protocol as to when RAD input was sourced and different methods of triage were being tried and tested over the course of my placement. The end of my time with them saw the prospect of the RAD team being based in the A&E department to increase awareness of the teams purpose and to avoid relying on appropriate referrals being made. I did not have any doubt that with a bit of perseverance this would happen and the RAD team in time would become much better established at the hospital.”'''''
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To meet the growing demands of emergency healthcare, EPPs operate as frontline staff whose role includes the assessment of musculoskeletal conditions, sending for further investigations such as bloods and scans, the management of soft tissue injuries and wounds an offereducation and advice. This allows for doctors working in the department to focus their attention to more complex acute cases and improves the flow of patients through the system. Frontline physiotherapists are particularly relevant in treating the elderly where admission to hospital is much more likely to result in a consequential spiral of hospital acquired infections, delirium and often reduced functional capacity, resulting in extended stays. An increasing elderly population and patients with two or more long term conditions has recently meant two out of three A&E visits are for those falling into these brackets and with increased access to GP out of hours services since 2004 there has been an additional 4 million A&E attendants <ref name="Rees, 2015">REES, S., 2015. Physios can, and should be used to relieve pressure on the NHS. Chartered Society of Physiotherapy [online]. [viewed 21 October 2015]. Available at: http://www.csp.org.uk/blog/2015/01/15/physios-can-should-be-used-relieve-pressure-nhs</ref>. In addition to this, increases in bed occupancy yet a 6% decrease in bed numbers since 2010 has seen patients being shifted between wards, putting further extension on their length of stay <ref name="Rees, 2015">REESᵇ, S., 2015. Physiotherapy can be the perfect pit stop. Chartered Society of Physiotherapy [online]. [viewed 21 October 2015]. Available at: http://www.csp.org.uk/blog/2015/01/29/physiotherapy-can-be-perfect-pit-stop</ref>
To meet the growing demands of emergency healthcare, EPPs operate as frontline staff whose role includes the assessment of musculoskeletal conditions, sending for further investigations such as bloods and scans, the management of soft tissue injuries and wounds an offereducation and advice. This allows for doctors working in the department to focus their attention to more complex acute cases and improves the flow of patients through the system. Frontline physiotherapists are particularly relevant in treating the elderly where admission to hospital is much more likely to result in a consequential spiral of hospital acquired infections, delirium and often reduced functional capacity, resulting in extended stays. An increasing elderly population and patients with two or more long term conditions has recently meant two out of three A&E visits are for those falling into these brackets and with increased access to GP out of hours services since 2004 there has been an additional 4 million A&E attendants <ref name="Rees, 2015">REES, S., 2015. Physios can, and should be used to relieve pressure on the NHS. Chartered Society of Physiotherapy [online]. [viewed 21 October 2015]. Available at: http://www.csp.org.uk/blog/2015/01/15/physios-can-should-be-used-relieve-pressure-nhs</ref>. In addition to this, increases in bed occupancy yet a 6% decrease in bed numbers since 2010 has seen patients being shifted between wards, putting further extension on their length of stay <ref name="Rees, 2015">REESᵇ, S., 2015. Physiotherapy can be the perfect pit stop. Chartered Society of Physiotherapy [online]. [viewed 21 October 2015]. Available at: http://www.csp.org.uk/blog/2015/01/29/physiotherapy-can-be-perfect-pit-stop</ref>
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In view of the tight window in which to see suitable patients, NHS London Care Commissioning Standards<ref name="NHS 2011">NHS HEALTHCARE FOR LONDON, 2011. Commissioning a new delivery model for unscheduled care in London. [viewed 21 October 2015]. Available at: http://www.londonprogrammes.nhs.uk/wp-content/uploads/2011/03/Unscheduled-care-commissioning-model.pdf</ref> state that many hospitals have reviewed their A&E services, extending emergency physiotherapy input to cover weekends and extended hours in order to maximise the cost-effectiveness of the service.Historically allied health professionals in A&E were occupational therapists due to their main role in the organisation of discharges. However, with the integration of health and social care advancing multidisciplinary team working, currently in situations such as these, there is an overlap in physiotherapist and occupational therapist roles in order to provide the best possible approach to patient-centred care.
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In view of the tight window in which to see suitable patients, NHS London Care Commissioning Standards<ref name="NHS 2011">NHS HEALTHCARE FOR LONDON, 2011. Commissioning a new delivery model for unscheduled care in London. [viewed 21 October 2015]. Available at: http://www.londonprogrammes.nhs.uk/wp-content/uploads/2011/03/Unscheduled-care-commissioning-model.pdf</ref> state that many hospitals have reviewed their A&E services, extending emergency physiotherapy input to cover weekends and extended hours in order to maximise the cost-effectiveness of the service.Historically allied health professionals in A&E were occupational therapists due to their main role in the organisation of discharges. However, with the integration of health and social care advancing multidisciplinary team working, currently in situations such as these, there is an overlap in physiotherapist and occupational therapist roles in order to provide the best possible approach to patient-centred care.
== Cost Effectiveness ==
== Cost Effectiveness ==