Allied Health professionals provide expert clinical and evidence-based stewardship; advanced scope physiotherapists are re-designing simple fracture patient pathways in the Emergency Department

Mr Piers Truter1,2,3, Associate Professor Caroline  Bulsara6, Associate Professor  Yusuf Nagree1,4, Associate Professor Katrina Spilsbury6, Dr Marshall Makate5, Dr Daniel Ng3, Ms Pippa Flanagan1, Ms Karen Mason1, Ms Susi Brooker3, Dr Karen Richards3,7, Associate Professor Dale  Edgar1,2

1Fiona Stanley Hospital, Murdoch, Australia, 2School of Physiotherapy, University of Notre Dame, Australia, Fremantle, Australia, 3St John of God Midland Public and Private Hospital, Midland, Australia, 4Harry Perkins Institute, Murdoch, Australia, 5School of Public Health, Curtin University of Technology, Bentley, Australia, 6Institute of Health Research, University of Notre Dame Australia, Fremantle, Australia, 7School of Physiotherapy, Curtin University of Technology, Bentley, Australia

Background of the project
A significant cohort of emergency department (ED) patients present with simple fractures; that is fractures that are usually managed conservatively and often referred back to primary care. In ED these patients are often managed by advanced scope physiotherapists. Preliminary audit of the whole department suggests that patient management may be driven by clinician preference / knowledge. Stewardship of the management of musculoskeletal injury is part of the value proposition of using physiotherapists in ED and we hypothesise that a more consistent approach informed by evidence from our health service’s specific context will improve care for patients and reduce costs for the health service.

We have developed a three-part process to gather information to inform recommendations to a West Australian EDs on managing simple fractures.

  • Retrospective patient treatment audit, with 6-month follow up post ED to map health service usage; variance in treatment; and, clinical and functional outcomes.
  • Patient interview to gain a consumer perspective on how and why they seek care for their injury through the ED
  • Survey of primary care clinicians (including allied health) to identify how primary care could be supported to better manage patients with simple fractures.

Results: Each month 40-60 patients attend the Fiona Stanley ED with simple fractures that could be managed elsewhere. 85% of patients self-refer to the ED. The proportion of patients referred to hospital specialist services is highly variable each month.

Discussion: Allied Health professionals provide high quality specialist patient care. In the current funding environment in health care, part of the value proposition for this specialist care lies in service development and stewardship. The process that we describe for reviewing the management of simple fractures from the Emergency department demonstrates how allied health professionals can contribute to developing a quality service though expert clinical and evidence-based stewardship.


Piers Truter is an Advanced Scope Physiotherapist in the Emergency Departments of Fiona Stanley and SJOG Midland Hospitals in Perth, WA. He has research interests in telehealth and emergency management of injury. He is a PhD candidate at the University of Notre Dame, Australia investigating the management of musculoskeletal injury in the emergency department. Connect with him on twitter @pierstruter.

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