Extended scope physiotherapists in the emergency department: a literature review

Background: Emergency departments (EDs) are one of the main providers of minor injury care in the UK. The use of extended scope physiotherapists (ESPs), independently managing patients from arrival to discharge, has not been widely considered in the UK or internationally. It is possible that ESPs will contribute to the staffing of the twenty-first-century EDs, and their role is gaining momentum in Australia, Canada, and several European counties. Objectives: The aim of the review was to establish the UK and international evidence for clinical effectiveness and cost efficiencies for ESPs independently managing a case load of 'minor injuries' in the ED setting. Methods: A comprehensive review of the published and non-published international literature was undertaken. Results: ESPs are independent professionals with pre-existing skills in the assessment and diagnosis of musculoskeletal injuries. Evidence was only found from UK hospitals regarding the clinical effectiveness and cost efficiencies. ESPs obtain equivalent clinical outcomes compared to the care provided by doctors of all grades, and they are likely to be equivalent in cost, but patients may take longer to return to normal activities when treated by an ESP. ESPs can work to existing ED protocols and achieve significantly higher patient satisfaction than other professional groups, but spend longer with patients. Conclusions: ESPs can provide a high standard of care at an affordable cost, whilst positively influencing patient satisfaction. The use of ESPs working in the ED, carrying out duties traditionally undertaken by doctors, could provide one of the solutions to staffing shortages in emergency care.