Member Spotlight: The Role of Physiotherapists in Ontario’s Emergency Departments: Natasha’s Story

When Natasha Bhesania graduated from the University of Toronto with a Master of Physical Therapy in 2007, she was immediately drawn to the intensity and complexity of acute care. She took on several roles across intensive care, neurotrauma, orthopedics, and general internal medicine units. A permanent role on Mount Sinai’s geriatric consult team eventually opened the door to a new opportunity that would push the boundaries of traditional physiotherapy practice.

Natasha initially began offering physiotherapy services in the emergency department for non-admitted patients. The goal was simple but powerful: to help avoid unnecessary hospital admissions. Recognizing the need for additional preparation, she completed several weekend courses on allied health in the emergency department to strengthen her skill set for this unique environment.

What started as a small 0.2 FTE addition to her full-time role quickly revealed its potential.

“I recognized the value of physiotherapy in the ED, particularly in preventing non-medical admissions, reducing length of stay through early mobilization, and facilitating discharge planning,” Natasha explains.

Inspired by this insight, she partnered with an occupational therapist colleague to launch a Science of Care quality improvement (QI) project. Together, they set out to demonstrate the impact of having full-time physiotherapy and occupational therapy coverage in the ED over a two week pilot as compared to baseline data of 0.2 PT/OT compliment over 2 years.

From 2020 to 2022, their data told a compelling story: patients moved through the system more efficiently, hospital length of stay decreased, and satisfaction among physicians improved. The results were strong enough to be presented at the International Learning Collaborative Conference in Portland, Maine in 2023. Natasha and her colleague’s work contributed to the receipt of funding from Ontario Health to support full-time PT and OT coverage in the emergency department. As of March 2025, the hospital now benefits from 12-hour physiotherapy coverage on weekdays and 8-hour coverage on weekends.

Natasha’s work goes far beyond managing mobility. In many cases, physiotherapy assessments have uncovered previously undetected conditions. “Our functional assessments have occasionally revealed neurological conditions such as strokes or early Parkinson’s Disease that were not initially detected through imaging,” she notes. While physiotherapists in the emergency department don’t order imaging directly, these findings have sparked collaboration with physicians that led to critical diagnoses including hidden fractures and strokes. It’s a powerful example of how physiotherapists contribute meaningfully to early diagnostic processes.

Innovative Care

Innovation is central to Natasha’s approach. Her team recently began integrating the Clinical Frailty Scale (CFS) into their initial assessments for patients over 65, which helps guide discharge pathways and ensures that both admitted and non-admitted patients receive the most appropriate care trajectory. It’s a data-informed strategy that enhances efficiency and targets resources where they’re needed most.

The impact is especially clear in key populations. “Our assessments are critical in the non-operative management of fractures following falls, particularly in older adults,” Natasha says. From prescribing gait aids and connecting patients to community resources and facilitating inpatient rehab applications directly from the emergency department, her interventions often help prevent avoidable hospital admissions. She also plays a pivotal role in managing pain for patients with musculoskeletal injuries, which is an area where early education and treatment can significantly affect outcomes.

Health System Impacts

Importantly, Natasha’s work supports broader system goals. By conducting early functional assessments, she helps minimize patient deconditioning, enables direct transfers to rehab, and contributes to smoother patient flow through the ED. “We are key contributors to disposition planning from the emergency department” she says. It’s a role that combines clinical skill with system thinking and it’s making a measurable difference.

To decision-makers across the health system, Natasha offers a clear message: “As our population ages and community resources remain limited, physiotherapists in the emergency department are essential for early assessment, mobilization, and discharge planning. We have the expertise to optimize function and facilitate safe transitions, whether back home or into rehab, directly from the emergency department.”

And while she’s passionate about advocacy, Natasha emphasizes that it must be grounded in evidence. The QI project she helped lead serves as a model not just for funding conversations, but for demonstrating the cost-effectiveness and value of physiotherapy in emergency care.

“Advocacy should be grounded in research and data,” she says. “By highlighting existing evidence, including our own QI project, we can demonstrate the value and cost-effectiveness of physiotherapists in emergency care.”

A Day in the Life

A day in Natasha’s life is fast-paced and ever-changing, which is exactly how she likes it. She starts by scanning the emergency department census to identify patients who could benefit from physiotherapy. These patients might be older adults recovering from a fall, individuals with musculoskeletal injuries, or those with mobility challenges or complex discharge needs. From there, she collaborates with the broader care team to determine who is medically stable and appropriate for physiotherapy intervention. Her work includes bedside assessments, gait aid prescriptions, education on safe mobility, and input on discharge planning, all of which is aimed at avoiding unnecessary admissions and ensuring safe, timely transitions of care.

“No two days in the ED are ever the same, and that’s part of what makes this role so dynamic and rewarding,” she reflects. It’s a role that blends clinical expertise, system navigation, and patient advocacy, and it shows just how far physiotherapy can go when professionals like Natasha are empowered to work to their full scope of practice.

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