# Exploring Advanced Practice Physiotherapist Scope of Practice by Discharge Diagnosis: A Review of 10 Years of Data From a Tertiary Hospital Emergency Department

## TL;DR

This study maps the scope of practice for advanced physiotherapists in an emergency department based on patient diagnoses over 10 years.

## Contribution

The study defines a specific scope of practice for physiotherapists using discharge diagnoses through a consensus process.

## Key findings

- APPs managed 37,771 episodes of care with 204 ICD-10 diagnoses covering 98.2% of cases.
- The scope included both adult and pediatric patients, as well as those arriving by ambulance or GP referral.
- APPs demonstrated capability to handle non-musculoskeletal diagnoses through a differential process.

## Abstract

Musculoskeletal conditions are the most common low acuity ED presentation. In response, over the last 13 years, Advanced Practice Physiotherapist (APP) roles have been established in emergency departments (ED) across Australia. Despite APP roles being well established in many Australian EDs, the current scope of practice for APPs as defined by discharge diagnosis is not accurately defined.

To derive a scope of practice based on ED diagnosis for APPs in an Australian tertiary hospital ED.

Descriptive classification study of patients who received care from an APP in the study ED between January 2015 and September 2024, with an iterative consensus process to establish the scope of APP practice by ED discharge diagnosis.

APPs provided 37,771 individual episodes of care with 388 assigned International Classification of Diseases (10th revision) (ICD‐10) discharge diagnoses. 204 ICD‐10 diagnoses were rated as representing the local scope of practice for ED APPs. These codes accounted for 37,000 (98.2%) of the episodes of care. The APP team provided care for 33,713 adult patients, 4058 paediatric patients, 1197 patients who arrived by ambulance and 3477 patients referred to the ED by a GP. The consensus process demonstrated that APPs have clarity on their scope of practice and the capability to manage a differential diagnosis process that includes non‐musculoskeletal diagnoses in the ED setting.

Using 10 years of ED data, a consensus process mapped the local scope of practice of APPs in a single Western Australian Tertiary Hospital ED to 204 ICD‐10 diagnoses.