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© 2023. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Objectives

Little is known about current practices in consulting physical therapy (PT) in the emergency department (ED) for older adults with falls, a practice that can reduce fall-related ED revisits. This qualitative study aimed to understand perspectives of ED staff about ED PT consultation for older adults with falls and fall-related complaints, specifically regarding perceived value and associated challenges and strategies.

Methods

We performed focus groups and key informant interviews with emergency physicians, advanced practice clinicians, nurses, physical therapists, occupational therapists, and technicians who perform ED geriatric screenings. We used rapid qualitative analysis to identify common themes related to decisions to consult PT from the ED, perceived value of PT, and common challenges and strategies in ED PT consultation.

Results

Twenty-five participants in 4 focus groups and 3 interviews represented 22 distinct institutions with ED PT consultation available for older adults with falls. About two thirds of EDs represented relied on clinician gestalt to request PT consultation (n = 15, 68%), whereas one third used formal consultation pathways (n = 7, 32%). Participants valued physical therapists’ expertise, time, and facilitation of hospital throughput by developing safe discharge plans and contact with patients to improve outpatient follow-up. Common challenges included limited ED PT staffing and space for PT evaluations; strategies to promote ED PT consultation included advocating for leadership buy-in and using ED observation units to monitor patients and avoid admission until PT consultation was available.

Conclusion

ED PT consultation for older adults with falls may benefit patients, ED staff, and hospital throughput. Uncertainty remains over whether geriatric screening-triggered consultation versus emergency clinician gestalt successfully identifies patients likeliest to benefit from ED PT evaluation. Leadership buy-in, designated consultation space, and formalized consultation pathways are strategies to address current challenges in ED PT consultation.

Details

Title
Physical therapy consultation in the emergency department for older adults with falls: A qualitative study
Author
Chary, Anita 1 ; Brickhouse, Elise 2 ; Torres, Beatrice 3 ; Cameron-Comasco, Lauren 4 ; Lee, Sangil 5 ; Punches, Brittany 6 ; Skains, Rachel M 7 ; Naik, Aanand D 8 ; Quatman-Yates, Catherine C 9 ; Kennedy, Maura 10 ; Southerland, Lauren T 11 ; Liu, Shan 10 

 Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA; Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA 
 School of Medicine, Baylor College of Medicine, Houston, Texas, USA 
 UT Health Science Center, University of Texas School of Public Health, Houston, Texas, USA 
 Beaumont Hospital, Royal Oak, Michigan, USA; School of Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA 
 College of Medicine, University of Iowa Carver, Iowa City, Iowa, USA 
 Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA; College of Nursing, The Ohio State University, Columbus, Ohio, USA 
 Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA 
 Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA; UT Health Science Center, University of Texas School of Public Health, Houston, Texas, USA; Consortium on Aging, University of Texas Health Science Center, Houston, Texas, USA 
 School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA 
10  Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA 
11  Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA 
Section
Geriatrics
Publication year
2023
Publication date
Apr 2023
Publisher
John Wiley & Sons, Inc.
e-ISSN
26881152
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2803499212
Copyright
© 2023. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.