New frontline role for physiotherapists in JGH Emergency Department

Physiotherapist Reshmi Varghese (left) and Lynn Gillespie, JGH Chief of Physiotherapy, in the hospital’s Emergency Department.
Physiotherapist Reshmi Varghese (left) and Lynn Gillespie, JGH Chief of Physiotherapy, in the hospital’s Emergency Department.

Initiative directs some ED patients to physiotherapists, cutting wait times

When Erika Villatoro Zamora turned to the JGH Emergency Department with severe shoulder pain recently, she expected a lengthy wait. After all, overloaded emergency rooms have been a fact of life in the Quebec healthcare system for years.

Instead, Ms. Villatoro Zamora got a surprise: She was treated by a JGH healthcare professional in one hour.

Physiotherapist Reshmi Varghese treats patient Erika Villatoro Zamora during a visit to the JGH Emergency Department.
Physiotherapist Reshmi Varghese treats patient Erika Villatoro Zamora during a visit to the JGH Emergency Department.

The reason? After triage, Ms. Villatoro Zamora was directed to a JGH physiotherapist rather than a physician. As a result, the 44-year-old was able to receive top-quality care with minimal delay in one of the busiest emergency departments in Quebec—all thanks to an initiative that’s already delivering promising results.

The Advanced Practice Physiotherapy (APP) project at the JGH directs certain patients with musculoskeletal difficulties—such as ankle sprains or back pain—to a physiotherapist who’s embedded in the ED team. Launched in March, 2023, the initiative has helped dramatically reduce patients’ wait times, while freeing up Emergency physicians to deal with other medical needs.

The project was recognized with an Award of Excellence by CIUSSS West-Central Montreal at its annual Public Information Meeting last November.

Nearly 600 patients benefited from the project between last March and November, and their average wait time in the ED was 3.8 hours—compared with 5.2 hours for patients with a similar profile prior to the initiative.

“Patients are very happy with the time I spend with them, and the fact they’re called in quickly,” says Reshmi Varghese, the Physiotherapist currently in the advanced role in the ED. She recalls a man in his 30s who came to Emergency one morning last fall after twisting his ankle playing soccer. Ms. Varghese assessed him, fitted him with a compression bandage and crutches, showed him exercises and sent him on his way—all in about an hour.

“He was shocked,” she says. The man had brought his lunch, dinner, snacks and several books to read for what he’d expected to be a day-long wait in Emergency. “What just happened? How did I get seen in an hour?” he asked, incredulous.

While the initiative helps alleviate overloaded Emergency rooms, it also highlights the skills of the JGH Physiotherapy team, says Lynn Gillespie, JGH Chief of Physiotherapy.

“As physiotherapists, we want to be able to use our expertise to the maximum, and here’s an example of where we can,” Ms. Gillespie says.

“It’s a real source of pride for our team. We’ve worked very hard to get here.”

Lynn Gillespie, JGH Chief of Physiotherapy

Data indicates that patients with musculoskeletal problems make up about 15 per cent of Emergency visits. Not only can physiotherapists assess these patients, who may suffer from pain and limitations to their mobility, but they can start them on the path to recovery by prescribing exercises and pain relief. Furthermore, since 2020, physiotherapists in Quebec have had the authority to order x-rays in some circumstances.

Accepting their Team category award for the Advanced Practice Physiotherapy project, at the CIUSSS West-Central Montreal Public Information Meeting in November: Julie Valiquette, Senior Advisor in Professional Practice for Rehabilitation and Multidisciplinary Services (holding the award), Lynn Gillespie, JGH Chief of Physiotherapy (third from left) and Meg Hoodspith, Clinical Activities Specialist, Emergency Department (fourth from left). 
They are congratulated by (from left) Alan Maislin, President of the Board of Directors; Dr. Lawrence Rosenberg, President and CEO; Lucie Tremblay, Associate CEO; Beverly Kravitz, Director of Human Resources, Communications, Legal Affairs and Global Security; and Gary Stoopler, Associate Executive Director.
Accepting their Team category award for the Advanced Practice Physiotherapy project, at the CIUSSS West-Central Montreal Public Information Meeting in November: Julie Valiquette, Senior Advisor in Professional Practice for Rehabilitation and Multidisciplinary Services (holding the award), Lynn Gillespie, JGH Chief of Physiotherapy (third from left) and Meg Hoodspith, Clinical Activities Specialist, Emergency Department (fourth from left). They are congratulated by (from left) Alan Maislin, President of the Board of Directors; Dr. Lawrence Rosenberg, President and CEO; Lucie Tremblay, Associate CEO; Beverly Kravitz, Director of Human Resources, Communications, Legal Affairs and Global Security; and Gary Stoopler, Associate Executive Director.

Patients are also more receptive than ever to seeing healthcare professionals other than physicians, Ms. Gillespie notes. “There are so many other healthcare professionals who can contribute to patients’ care. This enables physicians to devote their time and expertise to where it’s needed most.”

The project is the fruit of collaboration among several JGH teams: the JGH Physiotherapy Department that conceived and developed it with Professional Practice, the Medical and Nursing teams in the ED, the Radiology Department and others.

Dr. Alex Guttman, an ED Physician and key partner in the project, along with ED Physician Dr. Stephen Rosenthal, calls the initiative “a model that can be carried forward and expanded.”

Dr. Guttman says physiotherapists are able to spend more time with patients than a physician may be able to, and their approach to healing can take the route of exercises or other prescriptions that do not involve medication.

“Rather than just treating pain, they help the patient heal,” says Dr. Guttman, who is Assistant Director of the ED, as is Dr. Rosenthal. “This gives these patients good-quality musculoskeletal care that they would not necessarily get if they just saw physicians.”

“We work well as a team.”

Dr. Alex Guttman, Assistant Director of the JGH Emergency Department

To evaluate the project, the Physiotherapy Department has developed a formal patient survey in collaboration with the Directorate of Quality, Transformation, Evaluation, Value, Clinical and Organizational Ethics, and Virtual Care. However, anecdotal evidence has already indicated a high level of patient satisfaction. Ms. Villatoro Zamora reflected that sentiment. After seeing Ms. Varghese in the APP’s dedicated consultation room in the Emergency Department, Ms. Villatoro Zamora said that being treated by a physiotherapist was as reassuring to her as seeing a doctor. She was evaluated, underwent a variety of exercises and declared herself satisfied. “I got a diagnosis and treatment instead of waiting all day,” Ms. Villatoro Zamora said. “It’s fantastic.”