title: Primary contact physiotherapy in emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial.
abstract: OBJECTIVE
  To evaluate if direct physiotherapy assessment and management of patients presenting to emergency departments with musculoskeletal injuries (primary contact physiotherapy) results in reduced length of stay without any increase in adverse effects compared with secondary contact physiotherapy, where patients are seen by a physiotherapist after initial assessment by a doctor.
  
  
  METHODS
  Prospective non-randomised controlled trial.
  
  
  METHODS
  Three metropolitan emergency departments.
  
  
  METHODS
  Adults (n=315) presenting to emergency departments with peripheral musculoskeletal injuries were allocated to primary or secondary contact physiotherapy; 306 participants completed the study. Patients with serious pathology, open fractures and spinal pain were excluded.
  
  
  METHODS
  A single episode of physiotherapy.
  
  
  METHODS
  Primary outcome measures were patient length of stay, waiting time and treatment time. Secondary outcome measures were re-presentations to the emergency department, imaging referrals, patient satisfaction and emergency department staff acceptance.
  
  
  RESULTS
  Primary contact physiotherapy resulted in a reduction in length of stay of 59.5 minutes [95% confidence interval (CI) 38.4 to 80.6] compared with secondary contact physiotherapy, with a reduced waiting time of 25.0 minutes (95%CI 12.1 to 38.0) and a reduced treatment time of 34.9 minutes (95%CI 16.2 to 53.6). There were no differences between the groups in imaging referrals or re-presentations. Patients strongly agreed (≥82%) that they were satisfied with their management, and 96% of emergency department staff agreed that primary contact physiotherapists had appropriate skills and knowledge to provide emergency care.
  
  
  CONCLUSIONS
  Experienced musculoskeletal physiotherapists working in emergency departments can be the first point of contact for patients with simple, semi-urgent and non-urgent peripheral musculoskeletal injuries, resulting in decreased waiting times and length of stay for patients without any adverse effects.
authors.affiliation: Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia. N.Taylor@latrobe.edu.au
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Taylor
authors.forename: Emily
authors.initials: E
authors.lastname: Norman
authors.forename: Leanne
authors.initials: L
authors.lastname: Roddy
authors.forename: Clarice
authors.initials: C
authors.lastname: Tang
authors.forename: Anne
authors.initials: A
authors.lastname: Pagram
authors.forename: Kirsty
authors.initials: K
authors.lastname: Hearn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004632:Emergency Medical Services / Q000379:methods* / Q000458:organization & administration; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000293:injuries*; D010348:Patient Care Team / Q000458:organization & administration*; D017060:Patient Satisfaction; D026761:Physical Therapy Specialty / Q000379:methods* / Q000458:organization & administration; D015397:Program Evaluation; D011446:Prospective Studies; D011859:Radiography; D012017:Referral and Consultation; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation*; D055815:Young Adult