In TV hospital dramas, the emergency room is a place for trauma—the gushing-blood, broken-bone, mangled-limb variety. Those ailments don’t exactly fall into the wheelhouse of most physical and occupational therapists, which is why many ER or Grey’s Anatomy fans would be surprised to see a PT or OT cameo in an emergency department scene. But, as with many Hollywood-manufactured depictions of the world, this one doesn’t quite match up to real life. In fact, a growing number of hospitals are placing rehab therapists—including PTs and OTs—in their emergency rooms to help decrease patients’ chances of ending up in the ER again.

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Innovation in the ED

Evolving payment incentives are holding hospitals more accountable for what happens to patients post-discharge. If that trend continues—which it almost certainly will—hospital providers eventually will reach a point at which they can no longer afford not to account for patients’ at-home success within the course of treatment they receive at the hospital. And while many hospitals have adjusted their inpatient discharge planning processes to encourage better patient success rates once those patients return home, very few have extended their efforts to the emergency room. After all, many ER patients are released just hours after arriving at the hospital. But, what happens during those hours can have a significant impact on what happens after the patient leaves the emergency room, and a handful of innovative facilities—including Cape Cod Hospital in Provincetown, Massachusetts—have taken proactive steps to make the most of that time. Specifically, they’ve placed physical and occupational therapists in the ED to “identify functional limitations, address safety concerns, or assist in identifying the most appropriate facility for the next stage of care,” Rebecca Mayer Knutsen writes in this ADVANCE article.   

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Cost-Effective Readmission Defense

Because patients in the 55-plus age group make up such a large portion of Cape Cod Hospital’s patient population, emergency room staffers often see patients who are at a high risk for falls or who have trouble performing normal activities of daily living (ADLs)—two issues that fall smack dab in the middle of the rehab therapy wheelhouse. In fact, one might argue that no other type of healthcare practitioner is more qualified to address these particular needs. So, in an effort to better—and more efficiently—leverage their care resources, the leadership team at Cape Cod decided to implement a rehab therapy program within the hospital’s emergency department. “Our primary goal is to reduce revisits to the ED, reduce unnecessary admissions to the hospital, direct transfer protocols, and ensure safe discharge from the ED,” Christine Anstatt, a PT at Cape Cod Hospital, is quoted as saying in the above-cited article.

And because, as Knutsen explains, research “shows a strong correlation between the inability to perform ADLs and increased hospitalizations and higher mortality rates,” it behooves all hospital personnel—including those working in the emergency department—to assess and address those issues. So, before certain patients leave the ER at Cape Cod, therapists not only provide those patients and their caregivers with strategies for safely completing ADLs—such as dressing or washing themselves—but also “get a sense of the patient's home environment and physical limitations to identify needs.” That way, they can make recommendations for durable medical equipment—like bathtub grab bars—that can help prevent patients from re-injuring themselves.

But the benefit of providing rehab therapy services in the ED isn’t limited to improved clinical outcomes: compared to practitioners in other disciplines, PTs and OTs provide some of the most cost-effective services available for patients with neuromusculoskeletal issues. So, the hospital is not only keeping costs down in the current reimbursement framework, but also setting itself up for success in the emerging value-driven payment paradigm.

Team-Focused Training and Education

In addition to pushing the entire US healthcare system toward a quality-based model for payments, federal healthcare reform efforts are pushing providers to embrace a philosophy of truly patient-centered care. That means collaborating with all members of a patient’s care team to ensure the patient receives the best treatment—and experience—possible. To that end, the emergency room therapy staff at Cape Cod make it a point to educate their colleagues—including “physicians, nurses, ED technicians, and other primary medical personnel” on “the importance of ADLs to a patient's function and independence,” Knutsen explains. According to Kristen Siminski, a PT at Cape Cod Hospital, that effort has been well received: “Immersing ourselves in the ED has increased the staff's awareness of [therapists’] clinical skill-set and how we can positively impact a patient's discharge,” she said in the article.

Of course, like any new initiative, the ED rehab therapy program at Cape Cod Hospital still needs a lot of fine-tuning. But with the continued support of the hospital’s leadership teams, Siminski believes the program could bring the quality of care patients receive—and the outcomes they are able to achieve—to a whole new level as it helps “expedite the process for a safe discharge home within our community.” And that success could bring the trend of emergency-room rehab into the mainstream. Who knows—maybe one day we’ll even see an ER spin-off with a PT or OT in the starring role.

Have you heard of—or been involved with—an ED rehab therapy program? Do you think it’s a good idea to bring PTs and OTs into emergency care settings? Share your thoughts in the comment section below.

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