Tori Arca is the kind of physiotherapist who, like many in the profession, is always looking for a challenge and to learn and grow. As a new UBC graduate, she started her physiotherapy journey at Surrey Memorial Hospital working on various units including general medical, oncology, acute stoke, high acuity and nephrology. She also had the opportunity to work in the Pain Clinic at Jim Pattinson Outpatient Center. She loved the work she was doing there with chronic pain patients, but when that position ended and an opportunity came up to temporarily fill in for a full-time position in the emergency department, she jumped at the chance to take on something new.
Emergency department physiotherapy is an exciting and ever-changing area of public practice that requires an adaptable physio who is able to roll with the challenges of a fast-paced, unpredictable environment. Patients come into the ER with a wide range of health concerns—from fractures, to respiratory problems, to neurological issues—and the physiotherapist is tasked with a case load that reflects this variety. A physiotherapist in an emergency room can get up to 25 referrals a shift.
This environment was perfect for Tori.
“The ER physiotherapist needs to have knowledge in a variety of areas and be able to problem solve quickly,” she says. “When I was in school I loved anatomy, physiology, biology…etc. and I loved that in the ER you HAVE to use all that medical knowledge. You do full chart reviews and need to quickly determine the best course of action for someone based on their chart. Things move so fast—you have to know your stuff.”
Assessments, triage and intake are all part of the role of the physiotherapists in the ER, and they are involved in both active treatment and discharge planning for patients. They must make accurate treatment decisions from chart information that ranges from blood test results, blood pressure readings, imaging reports and what medications the patient is taking.
Active treatment scenarios include (but are not limited to): bracing patients with fractures; managing soft tissue injuries; treating and assessing patients with vestibular/neurological symptoms; dealing with patients in respiratory distress; and working with frail/elderly patients to get them moving after primary care. Discharge planning involves formulating a course of action for the patient before they are home; determining what kind of support they have access to/or will need once they are out of the hospital; and what functional goals need to be reached for their recovery. Patients may also be referred to outpatient physiotherapy if required.
Tori is quick to point out that physiotherapists are only one member of a dynamic, collaborative team (physicians, nurses, social workers, OTs, pharmacists, etc.) that work together to provide optimal care for ER patients. In many cases, physiotherapists build relationships with these patients beyond what other front line staff may have time to do. The team of physiotherapists at SMH are very close, having this support and the ability discuss clinical questions with each other is very helpful.
“People arrive in the ER scared and confused,” she says. “And although not directly physio-related, sometimes just holding patient’s hand and talking with them makes a big difference. And there are other ways to help you don’t realize…” She goes on to speak of a cancer patient who was in the ER with bone metastasis, in a lot of pain and near the end of life. Tori was able to make an impact by explaining anatomy of the bone affected and risks, and how the progressed disease would affect the patient’s ability to mobilize safely and why other methods may need to be considered. These are the moments when it becomes clear the role of the ER physiotherapist is deeper and more complex than we imagine. This is where we realise that, although emergency department physiotherapists are still few and far between, the value of the practice to patient experience cannot be underestimated.
She only worked in the emergency department for eight months, but in that short time Tori absorbed a huge amount of knowledge and made a significant impact. Because physiotherapists in emergency are the exception, not the norm, they are often under-represented and under-used. Tori worked hard to advocate for the profession. She worked to open the lines of communication with the other ER staff, and pushed to show her scope of knowledge and the value of her clinical reasoning.
Moving forward, the vision for physiotherapists in BC in emergency care is to further integrate the practice into front line assessments (i.e. have advance practice physiotherapists who can order imaging, assist in primary triage for example) and use physios to streamline patient discharge.
Physiotherapists in emergency departments must continue to work to show doctors and other health professionals their value, their scope of knowledge and why integrating physiotherapy into critical care is important now, and in the future. The more open dialogue and understanding, the more support.
Tori’s best advice: “show them what you can do”. This doesn’t just apply to the emergency room.
The ER is only one small area of public practice, but it is a shining example of how physiotherapists can make a difference in the approach to patient care. There is an endless pool of resources and support, and many exciting opportunities within the public realm available to those who want to grow their skills and expand their knowledge of physiotherapy and how it can help.
See more about physios in the ER in the Winter 2016/17 issue of Directions Magazine (login as a member to access). Our feature article Physios in the ER and the Changing Face of Health Care (p13-15) further explores the role of physios in the emergency room.