TABLE 2.

Illustrative quotations about common themes in ED PT consultation.

Theme	Quotation
Decisions to consult PT
Clinician discretion	“When I need to figure out the disposition for older adults who fall often the deciding factor is how well they are in terms of their physical health, so that they won't fall again… I rely on physical therapy to try to make that decision.” ‐Interview Participant 1 (physician)
	“We do not have a specific protocol for consulting physical therapy for older adults who fall. It's much more ad hoc. The majority of my colleagues do a modified Timed Up and Go and if you're an older adult and you can't walk across the room, and there's a concern that you're going to fall again if you are discharged–if it's during the day, PT will be asked to see the patient, but it's very ad hoc.” ‐FG 4, Participant 6 (physician)
	“If we have someone who has a fall that either doesn't result in an injury or someone who has repeated falls, but we're probably going to be sending them home, oftentimes we're just trying to figure out if it's really safe to send them home.” ‐FG 1, Participant 5 (advanced practice clinician)
Screening	“Every patient 75 and older is screened using the STEADI [Stopping Elderly Accidents, Deaths & Injuries] questions…If someone answers yes to any of those questions, then the [technician] will check orthostatic blood pressures and if negative they will do a functional screen.” ‐FG 3, Participant 7 (physical therapist)
	“In our screening that we do for falls, we are also asking about activities of daily living and social support, their home setup.” ‐FG 3, Participant 6 (technician)
Value of ED PT
Expertise	“I think their expertise is invaluable. You know your patient's getting a safety assessment, a thorough evaluation. I think that they are trained to do functionality tests that we would not even know how to begin to complete.” ‐FG1, Participant 4 (advanced practice clinician)
	“You have to dig in deeper to figure out everything that's going on. For instance, somebody could, you know, pass with a walker doing these activities, but they're also the primary caretaker of their significant other at home. So what do you do at that point? So those skills [to work in the ED] are really, really important.” ‐FG 3, Participant 3 (physical therapist)
Time	“I think it's our goal is really to be able to spend the time that other providers might not be able to look at the patient as a whole.” ‐FG 2, Participant 7 (physical therapist)
	“Sometimes just moving them can reveal something that them being stationary in the bed wouldn't tell you, or a different story. Just because we do have the luxury of … more time on them.” ‐FG 4, Participant 4 (physical therapist)
	“I think physical therapy also can dig a little deeper with asking more about their specific home setup, what durable medical equipment they have, and I think they also can do spend a little bit more time assessing their cognitive wherewithal as well, which may lend to a decision on placement.” ‐FG 3, Participant 5 (physical therapist)
Throughput	“The thought of being able to get a patient home that you otherwise wouldn't have felt confident about, I think is a huge value added in our system. And that's probably true for a lot of others, but our hospital primarily serves underserved and uninsured people. So I think it feels like a huge win any admission if you can avoid.” ‐FG 1, Participant 5 (physician)
	“What goes along with the case management is like the throughput and trying to clear out beds to get the waiting room numbers down.” ‐FG 2, Participant 8 (occupational therapist)
Continuity of care	“With PT coming down [to the ED], the patient compliance to the follow up to physical therapy–when we do follow up calls–is increased from what I can tell. When PT interacts with our patients versus just sending them home with a consultant saying, you know, somebody's gonna call you to schedule you a PT appointment. When our physical therapists have come down, the patients are actually making the follow up appointments or going to their next appointments or their video visits.” ‐FG 3, Participant 6 (technician)
Challenges
Resources	“Me personally embedding myself between the emergency department [and the floor]–I'm only there [in the ED] half the day, the other half seeing patients on the floor and managing all of that. Sometimes you'll get [consulted] to see somebody down there, but they're in a CT scan. So then you go up and see somebody else and just trying to figure all of that out is definitely difficult.” ‐FG 3, Participant 3 (physical therapist)
	“The off hours, that's kind of our biggest challenge–on the weekends and off hours or when our physical therapist is not here.” ‐FG 1, Participant 1 (nurse)
Ad hoc consultation	“Oftentimes if you have people with Parkinson's disease, they're just going to fall at home…and our provider [says], ‘We can't really send them home because they'll fall.’ And whereas the neurologist was like, well, we're really not going to solve that problem.” ‐FG 1, Participant 1 (nurse)
	“I don't think over‐consultation is a thing [I'm worried about]…Eventually, hopefully with time, it'll start becoming second nature and people will be able to see a patient [with a fall] and be like, ‘Okay, we should consult a physical therapist so they can work out a long term plan for this patient and make sure that they're okay in the long run.’” ‐Interview Participant 2 (physical therapist)
	“A nurse doesn't need to wait for PT to trial and ambulation with somebody. So that's something that we're actively working on at the hospital as well for the ED.” ‐FG 4, Participant 7 (physical therapist)
Strategies
Leadership Buy‐In	“So I think for the most part when you look at the big picture for health care systems, they want to facilitate this [ED PT consultations]. It's just a matter of how to and bringing the numbers to admin… I think is where we need more research so we can show numbers to admin and be like, this is where it's at.” ‐FG 3, Participant 5 (physical therapist)
	“So I think what's worked for us is getting as busy as we can to prove to my supervisors that we deserve more time down there.” ‐FG 3, Participant 3 (physical therapist)
ED Observation	“You know, we've we have the same space constraints as everybody else…We have an observation unit. Part of that workflow is that people can be in the observation pathway and see PT in the morning. So if that person needs a little more time to get things sorted out, that's been one of our solutions.” ‐FG 4, Participant 5 (physician)
	“We definitely leverage our observation unit very heavily…Again, the whole idea is that reducing one single admission is thousands of dollars of savings.” ‐FG 3, Participant 2 (physician)

Abbreviation: ED, emergency department; PT, physical therapy.