The definition of urgent/emergent care is important, yet difficult to quantify. The Saskatchewan College of Physical Therapists obtained legal advice, as well as direction from the ministry of health, to create the Practice Guideline below. This will be the foundation for treatment by physiotherapists and chiropractors providing in person care at Brownstone Health during the COVID-19 Pandemic. It is incredibly important to us, as a clinic, that we follow these guidelines explicitly.
Simply put, please book an emergent appointment if you are otherwise healthy and:
1. you have injured yourself and are contemplating going to the emergency department, primary health clinic or a hospital, we would like to help prevent overloading of an acute care system preparing for an influx of patients with the virus, by assessing musculoskeletal injury.
2. you have a condition that is going to get much much worse (to the point that you can not function) if you don't receive immediate care, we would like to help.
3. you have recently had surgery or an alternate medical procedure and require follow-up care in order to have a favourable outcome.
Here is the information provided by our Regulatory Body:
SCPT Practice Guideline
Determination of “urgent services or procedures” (COVID-19)
Background
The Chief Medical Health Officer for Saskatchewan issued a Public Health Order (PHO) on March 26, 2020 in relation to the current COVID-19 pandemic, prohibiting certain activities and ordering closures of some businesses. Clause 2(d) of the PHO orders all physical therapy clinics to only provide “urgent services or procedures” in person.
As always, all physical therapists are expected to work within the requirements of the Orders of the Government of Saskatchewan and the Federal Government, Legislation, SCPT bylaws, Standards of Practice and Code of Ethical Conduct.
Given the variety of practice settings and patient types, what is “urgent” may be defined differently in different settings. Therefore, the practitioner’s professional and ethical judgement to determine what is considered urgent with regards to their individual patients and situations will be imperative.
This Practice Guideline provides assistance to practitioners to make that determination.
Guiding principles and factors to consider in determining urgency
According to SCPT legal advice, a guiding principle in the decision making should be will the failure to provide the service or procedure result in serious harm to the patient.
Some factors to consider in determining urgency of care are:
- In the absence of physiotherapy services, is the patient likely to seek health-care services in an urgent care or emergency department setting?
- In the absence of physiotherapy services, is the condition likely to deteriorate to the point of requiring more intensive/invasive management by another health-care professional in the near- or medium-term?
- Is the patient’s condition significantly or severely impairing their ability to complete their activities of daily living or provide care to another individual, and if so, is their condition one that is amenable to active physiotherapy treatment?
- Would a physical therapy assessment or treatment allow for more efficient utilization of acute healthcare resources?
- Physiotherapists who are employed by Saskatchewan Health Authority are essential services. Physiotherapists that work in that setting must take direction from their employers to guide decision making.
Services or procedures provided to patients with these characteristics may be characterized as being of greater urgency.
Risk versus benefit of treatment
Physical therapists should also keep in mind the following provisions of the Code of Ethical Conduct:
7. Physical therapists shall not treat clients when the medical diagnosis or clinical condition indicates that the commencement or continuation of physical therapy is not warranted or is contraindicated;
8. Physical therapists shall request consultation with, or refer clients to, colleagues or members of other health professions when, in the opinion of the physical therapist, such action is in the best interest of the client.
Thus, if a patient possesses risk factors for the development of severe disease from COVID-19 (age over 60, co-morbid conditions, immunocompromised, etc.) this may mean that the risk of in-person physiotherapy service delivery is greater than the likelihood of benefit, in which case, in-person services should be deferred and appropriate referrals/education should be made.
Documentation
In each case the physical therapist shall document their rationale as to how and why they made the determination that the provision of physical therapy services or procedures to a patient was urgent or not urgent.
Pre-screening
It is recommended that, prior to providing any physical therapy services or procedures:
- all patients should be taken through a pre-screening questionnaire prior to any face to face treatments using the COVID-19 Self-Assessment tool: https://www.saskatchewan.ca/government/health-care-administration-and-provider-resources/treatment-procedures-and-guidelines/emerging-public-health-issues/2019-novel-coronavirus/covid-19-self-assessment)
- a screening should also be performed by the clinician to address the factors listed above in order to determine urgency of care requirements.
Treatment Precautions
- PPE (https://www.saskatchewan.ca/government/health-care-administration-and-provider-resources/treatment-procedures-and-guidelines/emerging-public-health-issues/2019-novel-coronavirus/information-for-health-care-providers#infection-prevention-and-control)
- The current recommendations from SHA for healthcare providers in ambulatory, outpatient and home care settings with regards to PPE are:
- Physical examination of patients without respiratory symptoms - PPE according to Routine Practices and Point of Care Risk Assessment, no additional PPE required
- Controls such as masks and gloves should not be used when interacting with asymptomatic patients.
- PPE use is reserved for use with patients with suspected/presumptive or confirmed COVID-19. These patients should not be attending for private practice physiotherapy services.
- Frequent hand hygiene and avoiding touching one’s face are essential.
- The current recommendations from SHA for healthcare providers in ambulatory, outpatient and home care settings with regards to PPE are:
- Physical examination of patients with suspected or confirmed to have COVID-19
- should not be seen for private practice physiotherapy services
- Droplet/contact precautions including: procedural mask, isolation gown, gloves, facial/eye protection
- Preventative Measures should be taken including:
- Environmental cleaning and disinfection of surfaces.
- Use of frequent hand hygiene and respiratory etiquette by both staff and patients.
- Reconfiguring clinical spaces (treatment beds, waiting areas) and altering staff and patient booking practices to adhere to social distancing and maximum attendance instructions of public health officials.
- The most effective prevention is to treat via telerehabilitation if at all possible.