An Audit of Referrals to Occupational Therapy for Older Adults attending an Accident and Emergency Department

Abstract

The greater number of older people in communities is reflected in their increasing demands on the services of accident and emergency (A&E) departments. Recognition of the complex needs of older adults attending A&E departments has resulted in many National Health Service trusts employing occupational therapists in these departments. The occupational therapists are required to assess and evaluate a patient's functional status and, using a team approach, to make decisions about his or her wider needs, including therapeutic requirements and social provision. In order to audit the provision of the occupational therapy service in an A&E department, data were collected monthly over a 3-year period in a single district general hospital on the referrals made by medical and nursing staff. The mean age of the patients referred was 80 years. The majority of the patients were female and living alone. The most common presenting problem was that of a fall, with a resulting fracture in half of the patients. The occupational therapy input in the A&E department was demonstrated in this study to save admissions to acute hospital care, amounting to an equivalent of two beds saved in each of the years covered by the audit.

Occupational therapy in emergency departments: Australian practice

“…Fifth, the primary role of occupational therapists working in EDs entailed the functional assessment of patients presenting to the ED to determine their suitability for discharge into the community or admission to the relevant inpatient ward of the hospital. This finding supports previous literature describing the role of OT in EDs [25,26,28–30,54].…”

“…Australian public hospital EDs are predominantly providing services to an older patient population (>65 years of age) and it appears this is also the primary patient population of occupational therapists in Australian EDs. This finding is similar to those from the UK and North America regarding OT service in ED [13,25–28,30]. As older people present more frequently to EDs than any other age group [6,44,45] and the Australian population is ‘ageing’[46,47]; it is reasonable to predict that there will be a greater need for OT services in EDs.…”

“…Other studies have identified some standardized assessments used in ED but this was not found here [13,27,28]. Interventions used in this study were consistent with previous ED literature including equipment prescription, patient (and family) education, home visits and minor home modifications and referrals to community services [13,25–30]. Occupational therapists in this study did not evaluate intervention outcomes using formal methods, and this fills a gap in the literature on this topic as this was not previously known.…”

“…Occupational therapists in this study did not evaluate intervention outcomes using formal methods, and this fills a gap in the literature on this topic as this was not previously known. Resources used by occupational therapists in this study were similar to those used in previous studies [25,26,28,30]. The most utilized resources were equipment, educational material/patient information, community services and assessments.…”

Abstracts

“…Or has it just be easier to not change working patterns? One major area of concern raised by a number of researchers has been the need for an occupational therapy service to operate outside standard working hours and to offer a 7 day a week service (Smith and Rees 2004). Carlill et al (2002) found that this was important because of the numbers of patients admitted on weekends, especially on Saturdays.…”