Evaluation of a clinical specialist physiotherapy service working in advanced practice in an emergency department setting.

BACKGROUND

Clinical Specialist Physiotherapists (CSPs) with an advanced scope of practice have been introduced internationally to Emergency Departments (EDs).

AIMS: To evaluate the activity, patient characteristics, clinical outcomes and emergency department process measures associated with an Irish ED CSP with an advanced scope of practice service.

METHODS

A retrospective service evaluation was undertaken of all patients managed by the ED CSP with an advanced scope of practice between 1 April 2023 and 31 August 2024 and 1 March 2025 and 15 March 2026. Demographic, clinical and operational data were extracted from the ED information system.

RESULTS

1,633 ED patients were managed by the CSP with an advanced scope of practice. The mean patient age was 43.6 (SD 16.2) years and 54.2% were male. Back pain (46.6%) and limb problems (42.3%) were the most common presenting complaints. Soft tissue injury (61.5%) and back pain (23.1%) were the commonest discharge diagnoses. Most patients were discharged with physiotherapy follow-up (58.6%) while only 60 patients (3.7%) required hospital admission. Fourteen admitted patients underwent urgent discectomy and decompression, and one case of cauda equina syndrome was identified. Mean ED length of stay was significantly shorter for CSP-managed patients than for the overall ED population (312.1 vs. 664.5 min, p < 0.05). Hospital admission rates were also significantly lower (3.7% vs. 28.5%, p < 0.05).

CONCLUSION

An ED CSP service was associated with reduced length of stay, low admission rates and appropriate identification of serious pathology, supporting the expansion of advanced physiotherapy roles within Irish emergency care.