Physical therapy consultation in the emergency department for older adults with falls: A qualitative study.
Physical therapy consultation in the emergency department for older adults with falls: A qualitative study.
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DOI：
10.1002/emp2.12941
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发表时间：
2023-04
影响因子：
2.3
通讯作者：
Liu, Shan
中科院分区：
文献类型：
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作者：
Chary, Anita;Brickhouse, Elise;Torres, Beatrice;Cameron-Comasco, Lauren;Lee, Sangil;Punches, Brittany;Skains, Rachel M;Naik, Aanand D;Quatman-Yates, Catherine C;Kennedy, Maura;Southerland, Lauren T;Liu, Shan
目前人们对急诊科(ED)为跌倒的老年人咨询物理治疗(PT)的做法知之甚少，这种做法可以减少跌倒相关的ED再次就诊。这项定性研究旨在了解ED工作人员对患有跌倒和跌倒相关疾病的老年人的ED PT咨询的看法，特别是关于感知价值和相关挑战和策略。我们对急诊医生、高级临床医生、护士、物理治疗师、职业治疗师和进行老年急诊筛查的技术人员进行了焦点小组和主要信息者的访谈。我们使用快速定性分析来确定与ED咨询PT的决定相关的共同主题、PT的感知价值以及ED PT咨询中的共同挑战和策略。4个焦点小组的25名参与者和3个访谈代表了22个不同的机构，为跌倒的老年人提供ED PT咨询。约三分之二的急诊医生依靠临床医生格式塔请求PT会诊(n=15，68%)，而三分之一的急诊医生使用正式的会诊途径(n=8.7，32%)。参与者重视理疗师的专业知识、时间，并通过制定安全的出院计划和与患者的联系来促进医院吞吐量，以改善门诊随访。共同的挑战包括有限的ED PT人员和PT评估空间；促进ED PT会诊的战略包括倡导接受领导层，以及使用ED观察单位监测患者并避免入院，直到PT会诊可用。老年跌倒患者的急诊PT咨询可能使患者、急诊室工作人员和医院吞吐量受益。老年筛查引发的会诊与急诊临床医生格式塔是否能成功识别出最有可能从ED PT评估中受益的患者，仍存在不确定性。领导力的接纳、指定的咨询空间和正式的咨询路径是应对教育和技术咨询当前挑战的战略。
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. 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. 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. 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.