Implementation of Imaging by a Physical Therapist in the Emergency Department to Assist With Differential Diagnosis

ABSTRACT Background and Purpose: Physical therapists embedded within the emergency department (ED) are quickly becoming standard in the United States, with multiple benefits relating to improved patient outcomes and increased clinical efficiency. No studies have yet described the benefits of physical therapists clinical reasoning skills related to ordering and interpretation of diagnostic imaging in the ED. As the number of states allowing physical therapist–initiated imaging orders has grown, it is essential for ED physical therapists to appropriately leverage this tool for improved patient examination and care. The purpose of this case report is to review 3 unique cases in the ED where a physical therapist enhanced patient outcomes through imaging in various constructs (ordering, interpretation of existing images). Case Description: We describe 3 patients who presented to the ED of a large urban academic medical center with a dedicated ED physical therapy program. Each patient was evaluated by an emergency medicine clinician (physician, physician assistant, or nurse practitioner), who consulted the embedded ED physical therapist to assist in the evaluation and treatment of clinical conditions relevant to physical therapy practice: suspected musculoskeletal (MSK)-related pain, trauma-related pain status postfall, and dizziness/imbalance. Outcomes: Each individual case demonstrates the way imaging can affect ED physical therapist differential diagnosis and play a role in effective patient care management while enhancing patient outcomes through expediting necessary care and/or medical intervention. Examples include expanding suspected musculoskeletal pain differential to peripheral vascular disease, altering medical team regarding concern for hip fracture after initial negative radiographs, and obtaining stroke diagnosis via magnetic resonance imaging (MRI) for a patient presenting with assumed peripheral vertigo. Discussion and Conclusion: As the number of states allowing physical therapist–initiated imaging orders has grown, it is essential for ED physical therapists to appropriately leverage imaging as a diagnostic tool for improved patient examination and care. Development of benchmarks for ED physical therapy competency in imaging will also facilitate clearer delineation of ED physical therapy as future specialty consistent with international standing.