Session 24: OT and early intervention

S24.1 How do occupational therapists and physiotherapists working in an acute hospital perceive their role and value in facilitating discharge home for patients who are receiving end-of-life care?

S24.2 Early occupational therapy input at emergency department (ED)

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S24.1 How do occupational therapists and physiotherapists working in an acute hospital perceive their role and value in facilitating discharge home for patients who are receiving end-of-life care?

Introduction: NHS hospitals are under pressure due to increased waiting lists, high patient throughput and poor staffing levels. Patients die in hospital but this is not always their preferred place of death. They may wish to return home, which requires a coordinated multi-disciplinary approach. Occupational therapists and physiotherapists can support with end-of-life hospital discharges. This study explores the perceptions of hospital-based occupational therapists and physiotherapists working with end-of-life patients and their role in aiming to get a patient home.

Methods: Qualitative design. Five occupational therapists and five physiotherapists within the same NHS hospital were recruited via convenience sampling. Inclusion criteria included being a fully registered occupational therapist or physiotherapist working in an inpatient setting. Semi-structured, individual interviews were audio recorded and transcribed verbatim. Data analysis was completed using reflexive thematic analysis.

Findings: Analysis led to three themes: appreciation of the unique role of therapy, coordination and leadership and early recognition a person is approaching end of life. And two central coordinating concepts: a coordinated end-of-life hospital discharge and missed opportunities for an end-of-life hospital discharge.

Discussion: Occupational therapists and physiotherapists can facilitate end-of-life discharge but there are barriers that can lead to the patient remaining in hospital and dying on the ward.

Discharge planning is complex and requires the multi- disciplinary team working together alongside the patient and their caregivers.

S24.2 Early occupational therapy input at emergency department (ED)

Problem: Unnecessary admissions – minimal utilisation of community resources, which does not adhere to the ‘Get It Right First Time’ initiative (National Health Service 2021)

Design and methods: Pre-data analysis: average of 101 new patient referrals and 218 follow-ups, diversion rate average of 69%. Staffing for the project included one senior occupational therapist and one assistant. Staff were based at emergency department (ED) triage. Patients were triaged on arrival and the occupational therapy process was commenced, prior to medical examination, if able to clinically justify and rationalise intervention. Data was analysed against pre-pilot data including: number of new patients; follow up contacts; diversion rate; onward referrals.

This project was approved and registered with the Trust’s Quality Service Improvement and Redesign (QSIR) team (NHS 2023).

Results: Identified an additional 48 patients over three weeks. 71% of these patients seen and safely diverted back into the community. 91% in insufficient time contacts across the team’s additional clinical footprint.

Conclusion: Commencing occupational therapy process earlier into the patients journey within the Emergency Department had a positive impact on admission avoidance and utilisation of community resources.

Theory: Quality improvement project followed QSIR principles. Get It Right First Time initiative.

Impact: Beneficial for admission avoidance; optimising community-based and person-centred care; creation of business case going forward to expand occupational therapy and integrated therapy provision at the front door.