Authors (including presenting author) :
Leung LFT(1), Cheung SCJ(1), Hui NP (1),Wong KKJ (1)
Affiliation :
(1) Occupational Therapy Department, United Christian Hospital
Introduction :
Recent research suggests that Occupational therapy is emerging as a profession within the context of emergency care and believed to be beneficial in clinical care of patients in a number of ways. With the support of the clinical teams including doctor and nurses, a pilot occupational therapy service in Emergency ward(EMW) in United Christian Hospital has started since October, 2018 with the aim to facilitate safe and early patient discharge from EMW & prevent unnecessary admission to acute-care ward, targeting at patient with cognitive impairment, fall and fall risk, pain and COPD.
Objectives :
After two year of implementation, a service review was conducted to assess the service efficiency, throughput, types of patients seen, interventions provided and the patient re-admission rate. The objective is to further improve in prevention of unnecessary ward admission and enhance direct safe discharge home, furthermore, to provide timely intervention to fulfill unmet functional needs.
Methodology :
The data of EMW cases in the period from October, 18 to September, 20 was reviewed. The following data were retrieved through CDARS, CMS discharge summary, episode history and case files. - The clinical information and demographic data of patient referred - Intervention and follow up provided by occupational therapists - Percentage of cases seen by Occupational therapist with direct discharge and ward admission - Re-admission rate of cases seen by occupational therapist.
Result & Outcome :
In the review period from October, 2018 to September, 2020, there were 337 and 417 cases referred to OT in 2018/19 and 2019/20 respectively, the referral rate has increased from 5.4 to 7.7%, an average of 1.3 FU per case.The re-admission rate of patients seen by OT dropped from 21.6% to 17.6% across the 2 years’ period. Case type referred include COPD (30%), Fall (22%), Chest pain and chest discomfort (16%) and other diagnosis (32%). Major interventions include ADL assessment, cognitive assessment, dyspnea management, fall assessment and prevention, pressure garment and pressure therapy for postural hypotension, etc. In 2018/19 40 patients were referred for COT FU for post discharge home assessment, 20 cases referred for post discharge OPD FU to continue cognitive rehabilitation, functional rehabilitation, assistive device or aids prescription follow-up. In 2019/20, 46 cases in total were referred for post discharge FU, due to the Pandemic outbreak this year. Since the start of service in Oct 18, the monthly attendance increased from 12 to over 40 per month, and core OT services were much more recognized by EMW staff. Introduction of COPD package in Feb, 19. Strengthened the role of OT in dyspnea self-management skills education and oximetry monitoring in ADL tasks, and also in assessing psychological factors in dyspnea management. The need for assessing patient’s cognition for early discharge also reflected in increasing number of such referrals. As OT in Emergency Ward is a newly emerged service, further consolidation OT service flow and triage, exploring other patient groups for OT service, e.g. heart failure, syncope and hypoglycemia, in order to improve service coverage and effectiveness, addressing patient safe direct discharge and reducing unnecessary admission is required.
