Clinical utility

What is occupational therapy’s clinical utility in the emergency department?

The first scientific paper on the topic of occupational therapy in the emergency department was published in 2001. The study, done in Toronto, showed the pertinence of OT intervention during discharge planning. Moreover, the authors proposed a decision tree that outlines the occupational therapy consultation process.

Also in 2001, a randomized clinical trial was conducted in the UK that compared an intervention group (n=19) receiving an occupational therapy assessment and a control group (n=20). At baseline, 51.2% patients had problems in performing one or more of four basic activities assessed. At the follow-up assessment, in the intervention group the proportion of patients having no problems with these activities increased by 54% over and above the change in the control group, compared with that at baseline. The results of this clinical trial also showed that more than 50% of seniors who visited the ED for minor trauma would have left the emergency department unable to perform certain basic daily activities.

In 2002, in the UK, within the scope of a retrospective study of 209 subjects who were followed for a period of eight months, it was shown that OT and social services interventions prevent unnecessary hospitalizations and decrease admission and readmission rates. The study recommended that OT services in the ED be offered seven days a week.

  • Carlill, G., Gash, E. & Hawkins, G. (2002). Preventing Unnessary Hospital Admissions: an Occupational Therapy and Social Work Service in an Accident and Emergency Department. British Journal of Occupational Therapy, 65(10), 440-445.

In 2004, once again in the UK, a prospective descriptive study conducted over a period of three years with 1036 patients who received OT services in the emergency department, and based on indicators of discharge related outcomes, return visits to the ED and hospitalization, concluded that occupational therapy interventions saved 306 admissions to acute hospital care, amounting to an equivalent of 2.24 beds saved in each of the years covered by the audit.

  • Smith, T. & Rees, V. (2004). An audit of referrals to occupational therapy for older adults attending an accident and emergency department. British Journal of Occupational Therapy, 67(4), 153-158.

In 2012, a study conducted in Denmark considered the impact of OT and physiotherapy services from a therapeutic point of view using a mixed qualitative approach that included audits, questionnaires and interviews with discussion groups made up of doctors and nurses from three collaborating departments. Using a numerical scale of 1–10, the results showed that OT’s overall impact scored 7.4 (CI 6.9-7.9). Regarding the clinical usefulness of OT services, doctors mentioned the added value contribution of occupational therapists in planning discharges, and nurses noted an improvement in care quality; the presence of the occupational therapist apparently opens up a broader perspective on patient functioning. In conclusion, interdisciplinary partners considered that occupational therapists made a valuable contribution to the patient pathway in the ED. The benefits are especially related to quick provision of aids and appliances as well as providing an overview of patient’s physical abilities, early mobilization and relay of information.

  • Bruun, I. H. and Nørgaard, B. (2014). Occupational therapy and physiotherapy benefit the acute patient pathway: A mixed-methods study. Journal of Nursing Education and Practice, 4(4), 172-182.