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Continuing our series on advanced

scope physiotherapy roles across

Australia, Annette Pickup, Andrew

Wong, APAM, and Leigh Marchetto,

APAM, provide an overview of

progress in NSW.

In 2013, the NSW Emergency Department

(ED) Network, in partnership with the

Emergency Care Institute (ECI), began a

project to investigate the impact emergency

physiotherapy practitioners (EPP) have on

wait times and length of stay for patients

who present with a musculoskeletal injury.

The aim was to determine if there is any

value add from this service compared to

the usual care provided. The study also set

out to assess patient and staff satisfaction

with of the ED physiotherapy service across

multiple hospital sites.

Preliminary results from the study showed

that on average, the EPP reduced waiting

times by 10 minutes and length of stay by

two hours for patients with musculoskeletal

conditions (triage categories 3, 4 and

5) who present to the ED. The results

also showed 100 per cent of ED staff

felt ED physiotherapists have the skills

and knowledge to provide appropriate

assessment, treatment and education to

specific patient groups, and 95 per cent of

ED staff felt ED physiotherapists made the

ED team more effective. Ninety five per cent

of patients felt adequate time was given to

patients to ask questions.

Wollongong Hospital is an example of how

the physiotherapist role has progressed in

the ED. Within the ED is the Minor Injuries

and Illness Unit (MIIU) sub-department

staffed by a nurse practitioner and

physiotherapy practitioner. The unit operates

independently of the input of the ED staff

specialists on patient care. A study on the

model of care found the MIIU had 5.12 per

cent of available ED treatment spaces but

was able to manage 8.8 per cent of total

ED presentations for the month of data

collection. The average length of stay for

top 10 presentations in the MIIU was 2hrs

6min whereas the average length of stay

(ALOS) for the rest of the department for

the same problems was 3hrs 21min. For all

other presenting problems to the ED, the

ALOS was five hours, while for MIIU it was

2hrs 42min hours. Musculoskeletal injuries

and disorders managed in this unit include

back and neck pain, simple fractures as

well as those requiring reduction, dislocated

joints requiring reduction, soft tissue injuries,

wounds and crush injuries. Independent

management of these patients requires

advanced practice skills involving X-ray and

CT interpretation, reduction techniques and

complex clinical reasoning.

Developing a statewide or national

training and credentialing pathway for

physiotherapists is important to ensure

the profession continues to grow. Unlike

Victoria and the ACT, NSW does not have

a formalised, professional development

pathway for primary contact ED


Local and legislative policy restrictions are

another barrier when negotiating primary

contact physiotherapist (PCP) rights in

EDs. Processes such as ordering certain

diagnostic imaging have been blocked at

some sites due to funding mechanisms

which allow local hospitals to receive

reimbursement from the government

when ordered by medical staff. Ordering

pathology tests may encounter similar

barriers. Moving forward, the ability for

the PCP to prescribe medication requires

engagement from the APA and other

national bodies to remove barriers in state

and national legislation.

To address this, the NSW ED network has

been active in talks with the physiotherapy

advisers and manager groups to discuss

the role of the PCP. The aim will be to

create a framework based on what’s

existing as well as Health Workforce

Australia competencies to assist in creating

a clear career pathway for current and

future ED physiotherapists. The network

is active in developing a ‘minimum

standard’ list of skills defined within

standard, advanced and extended scope

roles in the ED. With APA support and

legislative consultation, the development

of competencies/pathway will guide the

direction of professional development to

assist with credentialing.

While these frustrations are not unique,

it is important to highlight that advanced

practice is not only progressing

physiotherapy in the ED but other facets

of physiotherapy in NSW. Examples of this


Back and neck pain pathway triage

The physiotherapy department at Royal

North Shore Hospital (RNSH) has

appointed Trish Schlotfeldt, APAM, to co-

ordinate the back and neck pain pathway

proof of concept trial. Her role, under the

guidance of the advisory committee, is

to ensure patients who present to RNSH

Advanced practice: focus on NSW