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Advanced Practice Physiotherapy in SHED

This document is a summarised version of Allied Health DG -CC-Primary Care Physiotherapy in the Emergency Department. The summary has been created to combine best practice information into one document specific to the Emergency Department, and has been endorsed by the ED Leadership Team. Staff should review the PPG if they require further information.


This QRG provides an overview of the Advanced Practice Physiotherapy service within the SHED.


This document summarises the relevant guideline, so that it can be applied by all SHED staff.


The SHED Operations Manager and SHED Nurse Unit Managers (NUM) and Medical Directors are responsible for ensuring that all relevant staff are appropriately aware of the Advanced Practice Physiotherapy service.

Guideline/Process Details

Sunshine ED is staffed by Advanced Practice Physiotherapists who work in Fast Track and Adults, and Paediatrics. 

The Advanced Practice Physio will see Fractures ✓ Musculoskeletal injuries ✓ Back pain ✓  Adults ✓ Paeds ✓ Acute or Chronic conditions ✓ and more. APPs will pick up their own patients, and led management of care just as ED medical staff do.

An extended hours 7 day service was rolled out in October 2020, with the usual hours of APP cover in SHED now being 8:30am-7:00pm.

Benefits of the introduction of Advanced Scope Physiotherapy roles in the Emergency department include:

  • Reduced waiting times in ED (Matifat et al., 2019).
  • Patients seen by Advanced Practice Physiotherapy have less imaging and were prescribed less opiates (Schulz et al., 2016).
  • Equal or improved satisfaction levels compared to usual medical care (Matifat et al., 2019; Schulz et al., 2016).
  • Safe and effective management of patients with acute low back pain presenting to emergency departments (Sayer et al., 2017).
  • Positive patient experience and reduced wait times reported by patients (Fennelly et al., 2020)

The Advanced Practice Physiotherapist in ED will autonomously manage the following:

  • Category 3-5 patients within designated scope of practice
  • Adult or paediatric patients
    • Musculoskeletal conditions (trauma or otherwise) involving the following regions of the body: shoulder, elbow, wrist, hand, thigh, knee, ankle, foot.
  • Simple fractures
  • Adult spinal pain (lumbar, thoracic, cervical) with suspected musculoskeletal origin, without neurological change or fracture and with a definite mechanism
  • Atraumatic joint dislocations and spontaneously reduced joint dislocations

Patients who will be managed collaboratively with the ED Consultant or Senior Registrar include but are not limited to:

  • Category 2 patients if the presenting condition aligns to the parameters outlined in this document (eg. dislocated finger)
  • Patients with simple dislocations
  • Patients requiring fracture reductions (must have direct supervision of ED Senior medical staff)
  • Patients with injuries/conditions requiring medical intervention (e.g. open wounds, head injuries, history of anticoagulant therapy)
  • Patients with red flags
  • Patients who require medication other than paracetamol and ibuprofen
  • Patients with altered neurovascular status
  • Patients who need imaging other than plain film, with the exception of spinal imaging which will always be reviewed with the ED Consultant/ Senior medical staff
  • Patients who are TAC or workcover eligible may be managed by the Advanced Practice Physiotherapist in ED.  The Advanced Practice Physiotherapist  in ED will need to liaise with senior medical staff re: provision of the initial workcover certificate.
  • Patients with abnormal vital signs suggestive of pathology
  • More complex conditions eg. patient with a musculoskeletal injury subsequently reporting a head strike or subsequently found to have a wound requiring medical input.
  • Patients with spinal pain and neurological changes or without definite mechanism

It is a requirement that the Advanced Practice Physiotherapist in ED discusses these patients with the appropriate senior medical staff.

Regardless of being deemed competent, a collaborative, team-based approach to patient care is strongly encouraged at all times while working in the ED, and the physiotherapist should remain in close consultation with the ED consultant regarding any patient concerns.

Supporting Documentation

Document Governance

Title: Advanced Practice Physiotherapy in SHED
Version: 2.0
Date Published: October, 2021
Date of scheduled review: 01/02/2022
Author: Approver:
Sophie Gore SHED Leadership Team

Appendix 1: Primary Care Physiotherapy in the ED: Patient Flow Diagram