Background: A significant number of patients who present to the emergency department (ED) following a fall or with other injuries require evaluation by a physical therapist (PT). Traditionally, once emergent conditions were excluded in the ED, these patients would be admitted to the hospital for evaluation by a PT to determine whether they should be transferred to a sub-acute rehabilitation facility, could be discharged, require services at home, or require further inpatient care. Case management (CM) is typically utilized in conjunction with PT to determine eligibility for recommended services and to aid in placement. Objective: To evaluate the benefit of utilizing emergency department-based PT and CM services in lieu of routine hospital admission.
Methods: Retrospective, observational study of consecutive patients presenting to an urban, tertiary care academic medical center ED with an annual volume of 55,000 patients between 12/1/2017 and 11/30/2018 who had a PT consult placed in the ED. We evaluated the number of patients placed into ED observation for PT consultation, how many required CM, and their eventual disposition: whether they were discharged home with or without services, placed in rehab, or required hospital admission.
Results: During the 12 month study period, 1296 patients (2.4% of the total seen in the ED) were assessed by PT. The mean age was 75.5±15.2 and 832 (64.2%) were female. CM was involved in 91.8% of these cases. The final patient disposition was as follows: admission 24.3% (95% CI 22.1-26.7%), home discharge with or without services 47.8% (95% CI 45.1-50.5%), rehabilitation 27.9% (95% CI 25.6%-30.4). The median (interquartile range) time in observation was 13.1 (6.0-20.3), 9.9 (1.8-15.8) and 18.4 (14.1-24.8) hours for patients admitted, discharged home or sent to rehabilitation, p < 0.001. The median total time in the ED was 24.2 (18.2-30.4), 18.0 (11.9-24.1), and 28.6 (22.6-39.4) hours, p < 0.001.
Conclusion: Given that the standard of care would otherwise be an admission to the hospital for 1 day or more for all patients requiring PT/CM consultation, an emergency department-based physical therapy and case management system serves as a viable method to substantially decrease hospital admissions, reduce resource utilization and length of hospital stay, and potentially reduce cost both to patients and the healthcare system.