Not everyone who is seen for emergency treatment needs to be admitted to hospital. Many who are afflicted by sudden back pain and the like may only need some form of physiotherapy before being discharged from the A&E (accident and emergency department).

 

Not only will these patients with no other complications avoid having to be admitted or to return for an appointment to see a specialist first and a physiotherapy referral after, but expediting their care at that point also allows emergency medicine doctors to devote time to those with more serious conditions.

 

With that in mind, a physiotherapist has been attached to the Singapore General Hospital’s (SGH ) Department of Emergency Medicine since February 2012. The service is available every day between 9am and 6pm.

 

The A&E physiotherapist manages patients found to have no serious injury after initial investigations to determine the nature of their emergency.

 

 

These are patients with minor orthopaedic problems such as back, neck and knee pain, and don’t need surgery or to be seen immediately by an orthopaedic specialist; the elderly with a fracture or other complications following a fall; and those with vertigo, especially benign paroxysmal positional vertigo (sudden sensation of spinning). The last group is seen together with the otolaryngology team that deals with ear, nose and throat conditions.

 

Patients who need further attention are given appointments to be seen at the Physiotherapy Department within a week – unlike before when the process could take months. While waiting for his appointment, a patient might suffer another fall, requiring another visit to the A&E, said Ms Jennifer Liaw, Senior Principal Physiotherapist, SGH.

 

“We can’t eliminate all readmissions, but we play a role in those cases where we can help and make a difference through faster access to physiotherapy,” said Ms Liaw, the coordinator of the multi-disciplinary Early and Direct to Physiotherapy (ED-PT ) project. The team included Professor Celia Tan, Group Director, Allied Health, SingHealth, and Associate Professor Mark Leong, Senior Consultant, Department of Emergency Medicine, SGH.

 

After a physiotherapist was stationed at the A&E, the number of emergency referrals for physiotherapy increased by more than a third to 2,472 in 2014 from 1,836 in 2013. Most of these referrals – 54 per cent – were for patients with back pain. Patients requiring further investigation at the A&E’s Emergency Observation Ward and were seen by a physiotherapist also increased, to 816 in 2014 from 303 in 2013. Again, the majority of these cases were those with back pain (70 per cent). More than four-fifths of the Observation Ward patients seen by a physiotherapist were discharged, with just 17 per cent admitted to hospital ultimately.

 

Only experienced physiotherapists with at least five years on the job are scheduled for the service, as “the patients that we see in A&E are likely to be in acute pain, while geriatric and vestibular problems can be quite complex”, said Ms Liaw. “We want to ensure that we provide specialist care, the higher level of care, to this group of patients,” she added.

 

Currently, an A&E physiotherapist sees between four and 14 cases a day. Because the person at the A&E must be able to manage a spectrum of conditions, the ED-PT team had to undergo training from their colleagues in other specialities to ensure they are up-to-date in areas such as geriatrics, and neurological and vestibular rehabilitation.

 

 

The ED-PT project won the Groundbreaking, Effective and Momentous (GEM ) Award at the SingHealth Allied Health Innovative Practice Awards 2015, a recognition of the team’s positive impact as reflected by increased referrals from doctors, said Ms Liaw.

 

The project doesn’t stop there. The team is looking at whether nurses can play a role in helping patients with minor pain so that they can be discharged when a physiotherapist isn’t on duty in the evening. Another plan is to study which groups of patients with lower back pain – comprising a good percentage of A&E patients – may benefit from early physiotherapy, and if early interventions by physiotherapists will help to reduce readmission to the A&E and follow-up attendances at the orthopaedic specialist clinic.