Jennifer Hill
Clinical Specialist Occupational Therapist,
Chesterfield Royal Hospital NHS Foundation Trust
Tel: 01246 512177
Email: jennifer.hill@chesterfieldroyal.nhs.uk
Summary:
This new post of Clinical Specialist Occupational Therapist (OT) within emergency care offers rapid access to an assessment, with 70% of referrals being seen within 1 hour.
The aim is to facilitate a timely and effective discharge home.
Improved links with community resources has created a more ‘seamless service’ for patients transferred from emergency care to home or further rehabilitation facilities. This reduces the need for an unnecessary admission to an acute bed.
For the 65% of patients who returned home the OT provides a follow-up service to ensure discharge has been successful to thereby reduce readmission rates.
Abstract:
This post was developed in response to the standards outlined in the National Service Framework for Older People (2001). This is a proactive approach aiming to support people to return to their own homes, referring on for rehabilitation where required to assist patients to maintain a healthy and active lifestyle. Follow up work has also proved effective for falls patients, with increased liaison with local falls clinics and GP’s.
With a view to promoting a ‘patient-led NHS’ patients work with the OT to make an informed choice about their discharge and rehabilitation options, made easier by the OT Specialists own knowledge of local resources.
Chesterfield Royal has achieved the 98% target within A&E with regards to the 4 hour wait and this post compliments this by offering prompt assessment.
Significant time has been spent liaising with key professionals, for example, emergency care Matrons, Consultants and other multidisciplinary team members to develop the protocol for this post and to encourage their active involvement.
The aims of the role were presented to relevant departments and a daily presence in the emergency care department has increased the profile of occupational therapy and led to a significant increase in referrals (there have been 99 in the first 6 months compared to only 13 in 2004!)
The post has been welcomed throughout the Trust and following a six month baseline audit there have been continuous update presentations to professional groups regarding the benefits of the post.
Membership of strategic older peoples’ groups within and outside of the hospital has improved networks and increased participation in local projects working jointly across acute and community services.
The fact that this level of service was not available previously has meant that there has been an improved patient pathway through emergency care who do not require an acute admission.
.A patient satisfaction survey is ongoing and results collated so far indicate that those who have used the service have found this ‘very beneficial’. Patient feedback led to the introduction of an OT contact sheet which details arrangements made for discharge and OT contact details.
A staff survey is currently underway and informal feedback has been very positive. This has highlighted areas of change such as altering the OT working hours to better suit the needs of the service.
The protocol for this post has been developed and amended in consultation with the Trust Professional advisory Group, Clinical leaders and Clinical Governance Groups.
Since the introduction of this role the multi-disciplinary team have been working more closely and there has been a reduced duplication of assessments benefiting both staff and patients. The Specialist OT is able to assess referrals initially and then refer to other professionals as necessary and share information already gained.
The introduction of a dedicated OT has offered increased continuity for staff in emergency care who now have a better understanding of the OT role, leading to an increase in appropriate referrals.The protocol for this post was developed following visits to other similar, established local teams to gather evidence of good practice.
A six month audit has been completed using both quantitative and qualitative data. A patient satisfaction survey was undertaken and a staff survey is now underway.
Results from the audit demonstrate the role is has achieved the initial aims, for example, reducing unnecessary admissions to acute beds and facilitating a timely discharge home if appropriate.
This work has been presented at the Department of Health’s Learning Network Event (September 2005) and was published in an accompanying booklet alongside other examples of good practice nationally.
Case Scenario
Mrs X, aged 85, was referred to the Clinical Specialist OT following an admission to A&E. She had fallen outdoors and had sustained a fractured wrist.
The OT referred Mrs X to the social worker for assistance with personal care and meals and so she was able to be discharged home.
At this point, traditionally, the patient would have been discharged from the hospital OT. The Clinical Specialist was able to follow up the patient which meant that when her Plaster of Paris was removed 6 weeks later it was identified that she would require a referral for rehabilitation. This demonstrates how this role was able to improve the patient pathway by facilitating a more seamless service between acute and community services enabling the patient to regain her previous level of independence.
The Clinical Specialist OT liaises with patients to discuss discharge options from acute care, taking into account individual preferences. The use of sound local knowledge means that the OT can facilitate referrals to appropriate agencies post discharge.
Information on the progress of this post has been shared internally with the Professional Advisory Group, Clinical Governance Group, Clinical leaders Group, EMU Users Group and the Emergency Care Development Day.
The OT has been involved in House Officer Training regarding discharge planning and presented on the Post-graduate training programme.
The role has also been promoted via the Trust Quality Report.
Externally there have been presentations to colleagues in strategic groups in the local Primary Care Trust and also within social services departments.
The work was presented nationally at the Department of Health Learning Network Event in September this year.
It is hoped the work will also be circulated via the Rapid Intervention Specialist Section For Occupational Therapists where the information will be available on their website.
This role challenges traditional boundaries of the OT role within an acute hospital as it crosses the interface between acute and community/intermediate care services to improve the care pathway for patients attending emergency care.
The main thrust of the role is to act as a 'champion' for older people and act as an advocate to improve services to this client group.
