In November 2021, the Montreal Children's Hospital (MCH) became the first pediatric emergency department (ED), in Canada, to integrate physiotherapists directly into the ED team instead of seeking outside consultation. The current goal: to better treat concussions by reorganizing work to increase the support of physiotherapists in an integrated fashion.

As part of this pilot project, two pediatric physiotherapists are working directly in the ED three afternoons a week and will also be looking at some musculoskeletal traumatic injuries throughout the course of the winter.

Better concussion assessment

The MCH ED sees between 1,500 and 2,000 concussion cases per year. In the absence of biomarkers, their diagnosis relies solely on clinical judgment. Since the initial priority in the emergency department is to rule out serious intracranial injury, the more subtle concussion symptoms may go unnoticed.

This is where physiotherapists come in. They can take the time to seek out more information, conduct additional clinical tests and share the results with the care team. They make sure that all the necessary information is gathered to determine how long the child will have problems. They also give families more in-depth teaching on how to gradually return to their usual activities in a safe manner.

Similar projects with an adult clientele, notably at the CHUL, have shown that bringing physiotherapists directly into the ED has not only reduced wait times for patients with musculoskeletal injuries, but also avoided prolonged recovery and increased patient satisfaction.

"After the pilot project, we would like to be able to use physiotherapy in the emergency department for all conditions where it is needed," says Isabelle Gagnon, principal investigator, physiotherapist and project leader.

With the project ending in June, the data collected on the organization of the service, parent satisfaction and the cost of these new interventions will then be analyzed.