Physiotherapist-led ED care shortens musculoskeletal patient stays by one hour in NSW RCT

The University of Sydney-led RCT assigned adults presenting with musculoskeletal conditions to either standard physician- or nurse-practitioner care or physiotherapist-led assessment and management. Primary outcomes were total ED time, time to assessment, and proportion seen within triage benchmarks. Secondary measures included pain scores, quality-of-life indices, patient satisfaction, and 30-day adverse events. Economic modelling extrapolated annual savings of $19 million and 540,000 staff-hours if scaled statewide. The design was pragmatic, unblinded, and conducted in public hospitals serving mixed urban-rural catchments.

Compared with controls, the physiotherapist arm achieved a 40-minute faster first assessment and tripled the odds of meeting Australasian College for Emergency Medicine triage targets. Pain and function trajectories at seven and 30 days were statistically equivalent. Satisfaction scores favoured the intervention by 12 percentage points. No increase in missed fractures, unplanned returns, or opioid prescriptions was detected. These results align with earlier observational data from the UK and Canada but provide the first Australian RCT evidence with concurrent cost analysis.

Prior Australian pilots were limited by small samples or before-after designs that could not separate staffing effects from seasonal variation. The current trial’s cluster-randomised structure and pre-specified economic endpoint address those gaps. Remaining questions include generalisability to higher-acuity trauma centres, long-term workforce sustainability, and whether similar models reduce imaging overuse. A follow-up stepped-wedge implementation study across additional local health districts is planned for 2026-2027.

Evidence quality is moderate: a well-conducted multicentre RCT with patient-level randomisation and economic data, yet single-region, unblinded, and reliant on short-term surrogate endpoints. A larger, multi-state trial with 90-day functional outcomes and detailed diagnostic accuracy metrics would strengthen policy recommendations.