Discharging end-of-life patients from acute hospitals

The presentation

In her compelling presentation, Lindsay Vickerstaff delved into the nuanced world of end-of-life care discharge planning, specifically examining how occupational therapists (OTs) and physiotherapists perceive their role in supporting patients leaving acute hospital settings. 

Driven by her personal experience and job satisfaction working with end-of-life patients, Lindsay identified a significant gap in existing literature. Remarkably, there was minimal research exploring the perspectives of OTs and physiotherapists in this critical area, particularly from an acute hospital discharge standpoint. 

The study was grounded in the Department of Health and Social Care's definition of end-of-life care: patients rapidly deteriorating and approaching the terminal phase of their life. Lindsay's research aimed to understand the facilitators and barriers these professionals encounter and explore their perceived value within multi-disciplinary teams. 

Methodologically, Lindsay conducted semi-structured interviews with five occupational therapists and five physiotherapists across different hospital wards. Her participants were experienced professionals, ranging from two to over 20 years of qualification, deliberately excluding her immediate team to gain diverse perspectives. 

Using reflexive thematic analysis, she uncovered several pivotal insights. Her central organising concepts included coordination and leadership, appreciation of the unique role of therapy, and early recognition a person is approaching end-of-life. 

Key themes

Key themes emerged that illuminate therapists' contributions: assessments, advocacy, managing emotions, handling end-of-week pressures, and positive risk-taking. Participants emphasized they wanted to be more than seen as mere discharge planners – they sought recognition for their profession-specific skills and holistic approach. 

The research revealed that therapists play a crucial role in: 

• Quickly accessing essential equipment 
• Conducting manual handling and positioning assessments 
• Managing patient and family expectations 
• Identifying environmental factors influencing discharge 
• Advocating for patient choices 

Notably, the study highlighted that more experienced therapists felt better equipped to manage end-of-life patient discharges. They demonstrated confidence in making nuanced decisions, challenging traditional medical perceptions, and supporting patients' desires. 

A powerful example shared illustrated this approach: a patient deemed 'bed-bound' by medical colleagues was actually able to transfer with proper assessment, challenging preconceived limitations and demonstrating the value of holistic occupational therapy evaluation. 

Communication emerged as a critical factor. Therapists stressed the importance of early recognition that a patient is dying, involving patients in decision-making, clear documentation, and effective communication across multi-disciplinary teams and community services. 

Lindsay's research also highlighted potential areas for improvement, including: 

• Educational opportunities for new graduates 
• Addressing occupational deprivation 
• Supporting therapists in managing emotional complexities 
• Developing more comprehensive induction programmes 

The study's implications extend beyond individual patient care. It underscores the need for recognising therapists as skilled professionals who can navigate complex discharge scenarios, advocate for patient wishes, and provide nuanced, compassionate support. 

Looking forward, Lindsay expressed enthusiasm about potentially expanding her research, recognising the valuable skills she'd developed and the potential to further promote occupational therapy's critical role in end-of-life care.