Early occupational therapy input at Emergency Department

The presentation

In an innovative approach to healthcare delivery, occupational therapists Sophie Brisco and Jasmin Arts explored the potential of occupational therapy early intervention at the Emergency Department (ED) front door. Their quality improvement project was driven by several key NHS initiatives, including ‘Get it Right First Time’ and ‘Make Every Contact Count’, which emphasise proactive, patient-centred care. 

The pilot was meticulously designed with clear parameters: they would focus on patients over 65 with a Rockwood score of four and above, typically presenting with falls, vision issues, or collapses. Running the project for three weeks, Monday to Friday, they stationed themselves in the ED from 9am to 3pm, working alongside medical staff to identify patients who could potentially be managed in the community. 

Their objectives were multifaceted: to commence occupational therapy assessments earlier in a patient's journey, and to explore whether their early presence could positively influence patient pathways. The team was strategic, deploying a senior occupational therapist and a therapy assistant to ensure comprehensive data collection and support. 

The results were compelling. During the pilot, they saw an additional 48 patients beyond their typical referral caseload. Remarkably, 71% of these patients were diverted back into the community, avoiding hospital admission. This was achieved through intelligent use of community health and social care services, including care packages, community therapy teams, virtual wards, and rapid response services. 

The intervention allowed for more occupation-specific approaches. The team could conduct holistic assessments, focusing on patients' functional abilities, cognition, and psychological wellbeing. They weren't just looking at medical conditions but understanding the entire context of a patient's life and potential support needs. 

However, the pilot wasn't without challenges. The team experienced reduced coverage in other clinical areas, communication difficulties due to ED's high staff turnover, and their pilot was cut short when the Trust declared a major incident. They also noted practical constraints like lack of a dedicated workspace and limited access to online systems. 

Despite these obstacles, the project revealed significant potential. The team discovered they could challenge medical assumptions, advocate for patients, and prevent unnecessary admissions. One powerful example involved a gentleman who came in after a fall. Through their comprehensive assessment, they identified the reason for his suggested hospital admission was based on a condition already being managed, and he could safely return home with minimal additional support. 

The pilot's success has sparked interest within their trust. The consultant lead for frailty is now considering a similar project and wants occupational therapists directly involved. The team plans to develop a business case, though current financial constraints are delaying implementation. 

Key learnings included the importance of senior staff in building confidence, the value of early intervention, and the potential to reduce hospital pressures by intelligently using community resources. They recognised the need for continued education about occupational therapy's unique role in patient care. 

Ultimately, this project demonstrates the transformative potential of occupational therapy in acute settings. By providing holistic, patient-centred assessments early in a patient's journey, therapists can significantly impact healthcare delivery, reduce unnecessary hospitalisation, and support patients in maintaining their independence.