The role of the physiotherapist practitioner in emergency departments: a critical appraisal.
The quantity of literature available on the role of physiotherapist practitioners in EDs is severely limited, a situation that probably reflects the relatively recent introduction of the role. The quality of the literature, too, is variable; much of it is generalised and intended for presentation at conferences rather than as detailed analysis for publication. Nevertheless, the literature does identify two of the major benefits of employing physiotherapist practitioners in EDs: they enhance the ability of departments to meet government targets by reducing waiting times, and they are popular with patients. The extent to which physiotherapist practitioners might serve as an educational resource for other emergency care team members is also discussed. The disadvantages of employing physiotherapist practitioners in EDs mostly relate to their caseloads being so specific that, in smaller EDs in particular, there may simply be too few patients to make the role worthwhile. This can be offset, however, by the potential benefits of employing physiotherapist practitioners in review clinics. The narrow focus of practice and clinical skills identified in this review can however fragment the care that physiotherapist practitioners provide. Physiotherapist practitioners may not be trained in applying POP, for example, so cannot care for some patients continuously from admission to discharge or referral. These disadvantages should influence and guide training programmes, and inform individual EDs, when the introduction of physiotherapist practitioners is being considered. They may also aid decision making about what combination of staff EDs should employ, and what specific roles should be undertaken by different members of staff. The role of physiotherapist practitioners is fairly new and has been evaluated using different criteria that depend on the expectations of the role, which in turn are shaped by the rationale behind the role's introduction. This variation in role according to professional and service demands was acknowledged in work by Callaghan (2004), who also notes that the scope of practice of physiotherapist practitioners depends on local need, and that the future development of the role should have a more robust and larger evidence base. Much of the published evaluative activity focuses on the effect on service provision and patient satisfaction. This may be because these are more readily measured and can reflect on the objectives of those implementing the role. While the data identified in the literature are of value, more are needed to justify the position of physiotherapist practitioners in emergency care. These data should include information concerning patient episode times, patient satisfaction and the extent to which physiotherapist practitioners enable other practitioners to manage the care of other groups of emergency care attenders more effectively and quickly. It should also attempt to quantify the benefit of the role as an educational resource. More work needs to be undertaken concerning the nature and benefit of the role in different environments such as minor injury units or walk-in centres, as well as medium sized and large emergency departments. Similarly, the amount by which the role enhances physiotherapy services by encouraging staff retention and recruitment, and the development of new career pathways, also needs to be assessed. It is still too early to accurately describe how the role has fulfilled these expectations at Solihull. However, there are many physiotherapists now interested in working within the role should it continue and expand.