P151: Occupational therapy in the emergency department: sustaining results

Introduction: An emergency department visit may represent a sentinel event for someone who is older and frail, signalling a slide into dependence and functional decline. The gold standard for the treatment of frail older adults is a comprehensive geriatric assessment, involving consideration of multiple domains including mobility and function in activities of daily living. Despite this, when a chart audit was conducted in a Canadian metropolitan emergency department, none of the patients age 65 and older had a documented assessment of their function or mobility. In response, an occupational therapy program was implemented. The goals of this program were to reduce the number of unnecessary hospital admissions related to patient functional impairments, and to increase function, safety, and independence for patients upon discharge from the emergency department. Methods: The pilot project, which was completed in 2013, was evaluated using a mixed methods approach. Positive patient outcomes at that time included a reduction in avoidable admissions and better support for patients upon discharge from the emergency department. A survey of emergency department staff indicated that occupational therapy consultation added value to the diagnostic and discharge planning processes. However, due to changes in administrative priorities, several service redesigns were required. Multiple PDSA cycles were completed, and the development of a logic model guided and focused program development. Results: A reassessment of program objectives was conducted using 2015 data, which found that the number of patients seen by the occupational therapist remained the same, as did the percentage of patients discharged with support of occupational therapy intervention, such as provision of adaptive equipment or referral to community rehabilitation referrals. The percentage of patients discharged due to occupational therapy as a primary contributing factor rose slightly, and staff satisfaction with the program remained high. Conclusion: This evaluation proves that the provision of occupational therapy services in the emergency department is sustainable, benefits patients, and can be incorporated into the emergency department workflow and culture.

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Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab047 ◽

2021 ◽

Author(s):

Karoline Stentoft Rybjerg Larsen ◽

Marianne Lisby ◽

Hans Kirkegaard ◽

Annemette Krintel Petersen

Keyword(s):

Emergency Department ◽

Electronic Patient Record ◽

Hospital Admissions ◽

Functional Decline ◽

Patient Characteristics ◽

Risk Of Death ◽

Record Data ◽

Emergency Department Patients ◽

One Year ◽

Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

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Development of a Tool to Measure Clinical Competence in Occupational Therapy: A Pilot Study?

Canadian Journal of Occupational Therapy ◽

10.1177/000841740006700108 ◽

2000 ◽

Vol 67 (1) ◽

pp. 51-60 ◽

Cited By ~ 20

Author(s):

Penny Salvatori ◽

Sue Baptiste ◽

Maureen Ward

Keyword(s):

Pilot Study ◽

Occupational Therapy ◽

Clinical Competence ◽

Discharge Planning ◽

Program Planning ◽

Occupational Therapists ◽

Chart Audit ◽

Supervisor Ratings ◽

Stimulated Recall

Clinical competence is generally defined as a combination of knowledge, skill and professional behaviour. It is typically assessed using written tests, direct observation, chart audit, client satisfaction surveys and supervisor ratings. This paper describes the development and evaluation of a chart-stimulated recall (CSR) measure that combines the methods of chart audit and clinician interview to assess the clinical competence of practicing occupational therapists. The CSR tool was developed using the Canadian Guidelines for Client-Centred Practice and taps global domains of competence: use of theory, assessment, program planning, intervention, discharge planning, follow-up, program evaluation, clinical reasoning and professional behaviours. This pilot study involved two independent raters/interviewers who assessed twelve occupational therapy clinicians on two occasions using a random sample of client cases/records on each occasion Results indicate that the CSR tool is not only reliable and valid, but also sufficiently generic to be used in a variety of practice settings as a global measure of on-the-job performance.

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P121: Understanding health equity: a pilot project to collect socio-demographic information on emergency department patients at registration

CJEM ◽

10.1017/cem.2017.323 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S119

Author(s):

S. Vaillancourt ◽

M. McGowan ◽

C. Semprun ◽

P. Hannam ◽

G. Bandiera ◽

...

Keyword(s):

Emergency Department ◽

Data Collection ◽

Large Scale ◽

Capture Rate ◽

Tertiary Care ◽

Participation Rate ◽

Pilot Project ◽

Patient Data ◽

Structured Interviews ◽

Number Of Patients

Introduction: There is strong evidence that socio-economic factors such as income, housing and ethnicity are linked to health outcome disparities for emergency department (ED) patients. However, lack of real-time patient data has limited our ability to identify, understand and address health disparities. During a 14-week period, we assessed the feasibility and acceptability of the systematic collection of patient-level equity data in a busy tertiary care urban ED. Methods: We assessed feasibility by directly observing impact on registration time, percentage of patients on which data was collected, and ambulance patient data collection. We also assessed acceptability to patients, registration staff and clinicians through structured interviews of patients systematically sampled, focus group and surveys of registration staff and survey of clinicians. Results: Over the course of the study, equity data was collected on 2017 patients. Capture rate peaked in week 7 with 51% of eligible patients offered the equity questions and 30% answering. Average patient registration time increased from 215 seconds to 345 seconds (60%). Data collection with ambulance patients did not appear feasible. Patients (n=30) reported being comfortable with most questions except income (47% comfortable). 93% believed it could improve health services. However, a small number of patients voiced concern that the data could result in discrimination. Registration staff required sustained support and engagement, but some continued to feel uncomfortable with offering the questionnaire to some patients. Conclusion: Large scale collection of equity data is feasible but requires additional resources and sustained staff and patient support. Patient participation rate is likely to remain relatively low and is likely to underestimate disadvantaged groups. Data collection at multiple points within an institution may improve capture rate.

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Preventing Unnecessary Hospital Admissions: An Occupational Therapy and Social Work Service in an Accident and Emergency Department

British Journal of Occupational Therapy ◽

10.1177/030802260206501002 ◽

2002 ◽

Vol 65 (10) ◽

pp. 440-445 ◽

Cited By ~ 15

Author(s):

Gill Carlill ◽

Elizabeth Gash ◽

Glenis Hawkins

Keyword(s):

Emergency Department ◽

Social Work ◽

Occupational Therapy ◽

Hospital Admissions ◽

Community Support ◽

Accident And Emergency ◽

Therapy Services ◽

Accident And Emergency Department ◽

Set Up ◽

Published Research

In spite of the recent increase in occupational therapy services being provided to accident and emergency departments, and the anecdotal evidence that these are beneficial, there is very little published research to substantiate the need for such services. This paper describes the occupational therapy and social work service set up to serve an accident and emergency department in an acute NHS trust. The pilot service was audited after a 6-month period (December 1998 to May 1999) and the results of the audit are also presented. The results showed that the service was beneficial in terms of both preventing unnecessary hospital admissions and arranging suitable community support when patients were discharged home from the accident and emergency department. There were clearly ways in which the service could be improved and expanded; these are discussed, together with the implications of the results for future practice. The most important expansion for the service is an increase in staffing to allow 7 days a week cover.

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Prevalence of Hospital Admissions for Low Back Pain: Protocol for a Systematic Review and Meta-Analysis

10.31219/osf.io/ym9ka ◽

2020 ◽

Author(s):

Harrison J Lord ◽

Danielle Coombs ◽

Christopher Maher ◽

Gustavo C Machado

Keyword(s):

Emergency Department ◽

Low Back Pain ◽

Back Pain ◽

Length Of Stay ◽

Hospital Admission ◽

Hospital Admissions ◽

Functional Decline ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Low Back

Low back pain is the leading cause of years lived with disability in most countries and creates a huge burden for healthcare systems globally. Around the globe, 4.4% of all emergency department attendances are attributed to low back pain, and subsequent admissions to hospital seem to be common. These hospitalisations can result in unnecessary medical care, functional decline and high costs. There are no systematic reviews summarising the global prevalence of hospital admission for low back pain, identifying the sources of admissions or estimating hospital length of stay. This information would be valuable for health and medical researchers, front-line clinicians, and health planners aiming to improve and increase the value of their health services. The objectives of this study are to estimate the prevalence of hospital admission for low back pain from different healthcare facilities across the globe, including the emergency department, as well as investigate hospital length of stay and explore sources of heterogeneity when categorising studies according to low back pain definitions, sources of admission, study period, study setting and country’s region and income level.

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103 A Review of Reviews of Emergency Department Interventions for Older People: Outcomes, Costs and Implementation Factors

Age and Ageing ◽

10.1093/ageing/afz196.05 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i34-i36

Author(s):

J van Oppen ◽

L Preston ◽

S Ablard ◽

H Buckley Woods ◽

S Mason ◽

...

Keyword(s):

Emergency Department ◽

Older People ◽

Emergency Care ◽

Assessment Tool ◽

Discharge Planning ◽

Meta Analysis ◽

Functional Decline ◽

Reporting Standards ◽

Inclusion Criteria ◽

Review Of Reviews

Abstract Introduction Older people’s emergency care is an international public health priority and remains sub-optimal in the UK. Strategies are needed to manage older patients sensitively and effectively. We reviewed emergency care interventions, evaluating evidence for outcomes, costs, and implementation. Methods We developed and registered (with PROSPERO, CRD42018111461) a review of reviews protocol. Screening was according to inclusion criteria for subject and reporting standards. Data were extracted and summarised in tabular and narrative form. Quality was assessed using AMSTAR2 and Joanna Briggs Institute tools. Due to intervention and outcome heterogeneity, findings were synthesised narratively. McCusker’s Elder-Friendly Emergency Department assessment tool was used as a classification framework. Results Eighteen review articles and three conference abstracts fulfilled inclusion criteria. The majority were systematic reviews, with four using meta-analysis. Fourteen reviews reported interventions initiated or wholly delivered within the ED, and four focussed on quality indicators or patient preferences. Confidence was limited to each review’s interpretation of primary studies. Descriptions of interventions were inconsistent, and there was high variability in reporting standards. Interventions mostly focussed on screening and assessment, discharge planning, referrals and follow-up, and multi-disciplinary team composition and professional activities. 26 patient and health service outcomes were reported, including admissions and readmissions, length of stay, mortality, functional decline, and quality of life. Conclusions Our review of reviews demonstrated that the current, extensive evidence base of review studies lacks complexity, with limited or no evidence for the effectiveness of interventions; reviews commonly called for more primary research using rigorous methods. There is little review evidence for factors influencing implementation. There was evidence that among interventions initiated in ED, those continued into the community yielded better outcomes. Service metrics (as valued by care commissioners) were evaluated as intervention outcomes more frequently than person-centred attributes (as valued by older people). Interventions were broadly holistic in nature.

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Home Quick – Occupational Therapy Home Visits Using mHealth, to Facilitate Discharge from Acute Admission Back to the Community

International Journal of Telerehabilitation ◽

10.5195/ijt.2017.6218 ◽

2017 ◽

Vol 9 (1) ◽

pp. 47-54 ◽

Cited By ~ 12

Author(s):

Jacqueline Nix ◽

Tracy Comans

Keyword(s):

Patient Safety ◽

Occupational Therapy ◽

Process Evaluation ◽

Home Visiting ◽

Community Hospital ◽

Discharge Planning ◽

Home Visits ◽

Occupational Therapists ◽

Alternative Technologies ◽

Number Of Patients

This article reports upon an initiative to improve the timeliness of occupational therapy home visits for discharge planning by implementing technology solutions while maintaining patient safety. A community hospital in Queensland, Australia, hosted a process evaluation that examined which aspects of home visiting could be replaced or augmented by alternative technologies. Strategies were trialled, implemented and assessed using the number of home visits completed and the time from referral to completion as outcomes. A technology-enhanced solution called “Home Quick” was developed using technology to facilitate pre-discharge home visits. The implementation of Home Quick resulted in an increase in the number of home visits conducted prior to discharge (50% increase from 145 to 223) and significantly increased the number of patients seen earlier following referral (X2=69.3; p<0.001). The substitution of direct home visits with technology-enabled remote visits is suitable for a variety of home visiting scenarios traditionally performed by occupational therapists.

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Impact of lockdown during the COVID-19 pandemic on number of patients and patterns of injuries at a level I trauma center

Wiener klinische Wochenschrift ◽

10.1007/s00508-021-01824-z ◽

2021 ◽

Author(s):

Arastoo Nia ◽

Domenik Popp ◽

Cornelia Diendorfer ◽

Sebastian Apprich ◽

Alexandru Munteanu ◽

...

Keyword(s):

Emergency Department ◽

Trauma Center ◽

Injury Severity ◽

Hospital Admissions ◽

Severe Injuries ◽

Injury Death ◽

Health Crisis ◽

Number Of Patients ◽

Level I ◽

The Impact

Summary Objective The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) and its associated illness, coronavirus disease 2019 (COVID-19), has led to a global health crisis burdening frontline emergency departments, including orthopedic and trauma units. The aim of this study was to provide an overview of the impact of the lockdown secondary to the pandemic on patient numbers and pattern of injuries at the department of traumatology of the Medical University of Vienna. Methods This retrospective, descriptive study identified all patients admitted and enrolled onto the trauma registry at a level I trauma center, between 15 March 2020 and 30 April 2020 (lockdown) and compared them to those between 15 March 2019 and 30 April 2019 (baseline). Variables collected included patient age, sex, reason for hospital admission, place of injury, death, injury severity score (ISS), as well as American Society of Anaesthesiologists (ASA) score. Results A total of 10,938 patient visits to the trauma emergency department were analyzed, 8353 presentations during the baseline period and 2585 during lockdown. Only 1869 acutely injured and 716 follow-up patients presented during lockdown, compared to 6178 and 2175, respectively, during baseline. Throughout the COVID-19 lockdown there were significant reductions in both workplace and traffic accidents, sports injuries, number of hospitalized patients, and overall visits to the trauma emergency department; however, the number of major traumas and hip fractures remained similar. Furthermore, there was a significant increase in the frequency of injuries at home as well as hospital admissions due to attempted suicide. Conclusion Despite the reduction in total number of patients, trauma departments should continue to provide adequate service during lockdown considering that severe injuries showed no change. Conditions such as breakdown of social networks and limited access to mental health care and support might account for the significant rise in hospital admissions due to suicides. We recommend that more attention and effort should be made to prevent this excess of suicide deaths.

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Analysis of Deliberate Self-Wrist-Cutting Episodes Presenting to the Emergency Department

Crisis ◽

10.1027/0227-5910/a000361 ◽

2016 ◽

Vol 37 (2) ◽

pp. 155-160 ◽

Cited By ~ 2

Author(s):

Jin Kim ◽

Han Joon Kim ◽

Soo Hyun Kim ◽

Sang Hoon Oh ◽

Kyu Nam Park

Keyword(s):

Emergency Department ◽

Medical Records ◽

Attempted Suicide ◽

Suicide Attempts ◽

Psychiatric Interview ◽

Clinical Variables ◽

Completed Suicide ◽

Number Of Patients ◽

Group A ◽

Efficacy Of Treatment

Abstract. Background: Previous suicide attempts increase the risk of a completed suicide. However, a large proportion of patients with deliberate self-wrist cutting (DSWC) are often discharged without undergoing a psychiatric interview. Aims: The aims of this study were to investigate the differences in the characteristics and outcomes of patients with DSWC and those with deliberate self-poisoning (DSP) episodes. The results of this study may be used to improve the efficacy of treatment for DSWC patients. Method: We retrospectively reviewed the medical records of 598 patients with DSWC and DSP who were treated at the emergency department of Seoul Saint Mary's Hospital between 2008 and 2013. We assessed sociodemographic information, clinical variables, the reasons for the suicide attempts, and the severity of the suicide attempts. Results: A total of 141 (23.6%) patients were included in the DSWC group, and 457 (76.4%) were included in the DSP group. A significantly greater number of patients in the DSWC group had previously attempted suicide (p = .014). A total of 63 patients (44.7%) in the DSWC group and 409 patients (89.5%) in the DSP group underwent psychiatric interviews. Conclusion: More DSWC patients had previously attempted suicide, but fewer of them underwent psychiatric interviews compared with the DSP patients.

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