title: Physical therapy in the emergency department: development of a novel practice venue.
abstract: OBJECTIVE
  The American Physical Therapy Association's Vision 2020 advocates that physical therapists be integral members of health care teams responsible for diagnosing and managing movement and functional disorders. This report details the design and early implementation of a physical therapist service in the emergency department (ED) of a large, urban hospital and presents recommendations for assessing the effectiveness of physical therapists in this setting.
  
  
  METHODS
  Emergency departments serve multiple purposes in the American health care system, including care of patients with non-life-threatening illnesses. Physical therapists have expertise in screening for problems that are not amenable to physical therapy and in addressing a wide range of acute and chronic musculoskeletal pain problems. This expertise invites inclusion into the culture of ED practice. This administrative case report describes planning and early implementation of a physical therapist practice in an ED, shares preliminary outcomes, and provides suggestions for expansion and effectiveness testing of practice in this novel venue.
  
  
  RESULTS
  Referrals have increased and length of stay has decreased for patients receiving physical therapy. Preliminary surveys suggest high patient and practitioner satisfaction with physical therapy services. Outpatient physical therapy follow-up options were developed. Educating ED personnel to triage patients who show deficits in pain and functional mobility to physical therapy has challenged the usual culture of ED processes.
  
  
  CONCLUSIONS
  Practice in the hospital ED enables physical therapists to fully use their knowledge, diagnostic skills, and ability to manage acute pain and musculoskeletal injury. Recommendations for future action are made to encourage more institutions across the country to incorporate physical therapy in EDs to enhance the process and outcome of nonemergent care.
authors.affiliation: Physical Therapy and Orthopaedic Surgery, Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Blvd, Suite 1101, St Louis, MO 63108, USA. flemingd@wusm.wustl.edu
authors.forename: Debra
authors.initials: D
authors.lastname: Fleming-McDonnell
authors.forename: Sylvia
authors.initials: S
authors.lastname: Czuppon
authors.forename: Susan S
authors.initials: SS
authors.lastname: Deusinger
authors.forename: Robert H
authors.initials: RH
authors.lastname: Deusinger
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008923:Missouri; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000628:therapy*; D026761:Physical Therapy Specialty; D015397:Program Evaluation; D012017:Referral and Consultation