OTs at work in the ED
The occupational therapy practice models supporting the occupational therapist’s assessments in the emergency department rely on the interactions between a person and the environment in which his or her daily activities and social interactions take place.
In 2007, Nathalie Veillette and her collaborators completed the first descriptive study of OT practice in Quebec’s emergency departments, in which they documented the various aspects of the practice, including the nature of the requests received by occupational therapists. The requested assessments covered — in order of frequency — cognitive abilities, daily activities, safety upon return home, dysphagia and mobility.
- Veillette, N., Demers, L. & Dutil, E. (2007). Description de la pratique des ergothérapeutes du Québec en salle d'urgence. Canadian Journal of Occupational Therapy, 74(4), 348-358. http://dx.doi.org/10.2182/cjot.07.006
Data were updated following a 2014 survey of occupational therapists who are members of the Ordre des ergothérapeutes du Québec. An article in preparation by Bellemare & Veillette will describe the evolution of the practice in Quebec’s emergency departments.
In a presentation given at the Canadian Association of Occupational Therapists’ (CAOT) conference in Fredericton in 2014, JessieTrenholm (Jessie.Trenholm@AlbertaHealthServices.ca) described the various roles of occupational therapists practicing in emergency departments using examples from real situations that occurred during an occupational therapy pilot project at Rockyview General Hospital (Calgary, Alberta). Among other things, she explained occupational therapy through various clinical cases and how her recommendations made it possible to change discharge dispositions thereby avoiding unnecessary admissions and preventing unsafe returns home.
- Trenholm, J. (2014, May). The role of the occupational therapist in the emergency department. Session presented at the CAOT conference, Fredericton.
- Trenholm, J. (2014, May). The Benefits Of Providing Occupational Therapy In A Canadian Emergency Department. Poster presented at the CAOT conference, Fredericton.
An Australian study has described the occupational therapy services provided in emergency departments. It concluded that the OT’s role was consistently focused on functional assessment and on provisions of interventions such as equipment prescription, patient education and referral to community and support services to ensure safe discharge or inform inpatient admission decisions.
- Cusick, A., Johnson, L. & Bissett, M. (2009). Occupational therapy in emergency departments: Australian practice. Journal of Evaluation in Clinical Practice, 15(2), 257-265. http://dx.doi.org/10.1111/j.1365-2753.2008.00991.x
A Swedish study took on the question of how Swedish occupational therapist perceive their work in the emergency department, as well as the different strategies they used to develop their professional practice. Using a qualitative descriptive approach to analyze the content of 14 interviews, the study showed that occupational therapists feel that ‘occupation’ is the central theme of their work and that their practice is well recognized within the context of emergency care. The results mention different strategies for showing the effectiveness of occupational therapy and its approaches for patients and other health professionals. In contrast to other studies on this topic, Swedish occupational therapists had little difficult defining occupational therapy and presenting convincing arguments regarding their interventions. In summary, these Swedish OTs seem to have been provided with a professional language and the knowledge required to establish themselves in an emergency-care setting.
- Spang, L. & Homlqvist, K. (2015). Occupational therapy practice in emergency care: Occupational therapists’ perspectives. Scandinavian Journal of Occupational Therapy, 22(5), 345-354. http://dx.doi.org/10.3109/11038128.2015.1033455
A group of Scottish occupational therapists (Fraser et al., 2005) published guidelines regarding the practice of occupational therapy in the accident and emergency department. In these guidelines, the goals of occupational therapists are to prioritize patients who will be discharged and assess them in order to ensure safe return home upon discharge from the emergency department, identify patients that require follow-up occupational therapy services (either in an outpatient clinic or through traditional service) and play an active role in the multidisciplinary discharge process for patients returning home directly from the emergency department.
Initial assessments performed by occupational therapists in the emergency department focus on cognitive abilities (attention, orientation, problem resolution, memory and mood), transfers and functional mobility (movements necessary to perform simple and functional tasks, such as getting dressed). More comprehensive assessments can be done as needed and will focus on daily activity assessments and kitchen-use assessments, cognitive assessments and in-home assessments.
- Fraser, S., Mearns, N., Millar, A., Murray, F. & Wardlaw, F. (2005). Occupational therapy best practice guidelines for acute medical services. Retrieved from http://acutemedicine.org.uk/wp-content/uploads/2013/02/ohguidelines.pdf
Additional information regarding the practice of occupational therapy in the emergency department in Scotland is mentioned in another document (Armstrong, 2010). In the article, it is mentioned that occupational therapists and physiotherapists who work in the emergency department conduct quick functional assessments that can include the following: consent, cognition and communication, history of falls, pain, sensory-motor assessment, functional assessment (sitting-standing transfers, balance, using of stairs, daily activities, social support).
- Armstrong, C. (2010). Welcome to emergency medicine at the Royal Victoria Infirmary occupational therapy department. Retrieved from https://www.northumbria.ac.uk/static/5007/hces/rviemergmed_otpolo.pdf
Characteristics of the practice of occupational therapy in the emergency department
Occupational therapists who practice occupational therapy in the emergency department must deal with particular issues that fall under six main themes.
- Tight deadlines in which to respond to requests.
- A physical environment that is problematic for occupational therapists who wish to have a better-adapted space to assess occupation-based performance in daily activities and engage their clients in discussions.
- A lack of time in which to intervene and meet the needs detected in the emergency department clientele that forces occupational therapists to prioritise certain areas of functioning, to the detriment of those they have identified overall.
- Lack of coordination between the various professional services sometimes causes problems such as scheduling conflicts between diagnostic tests and professional consultations that waste the time of responders and foster feelings of frustration.
- Lack of knowledge regarding the occupational therapist’s role, which leads to inappropriate referrals. Occupational therapists are sometimes asked to respond to requests that do not fall under their area of expertise or that are not pertinent to OT assessment.
- The heavy mental load of the intense work pace, the extent and complexity of the problems seen in the emergency department clientele.
Emergency department clientele with cognitive impairment
A significant proportion of senior clients who visit emergency departments exhibit cognitive impairment (Thompson & Allen, 2008, Samara et al. 2010, Chiovenda et al. 2002). According to various sources, and depending on the clinical settings of the countries in which the studies were done, the proportions vary between 21% and 42% (Sampson et al., 2009; Gray et al., 2003; Clevenger et al., 2012).
- Chiovenda, P., Vincentelli, G. M. & Alegiani, F. (2002). Cognitive impairment in elderly ED patients: need for multidimensional assessment for better management after discharge. The American Journal of Emergency Medicine, 20(4), 332-335. http://dx.doi.org/10.1053/ajem.2002.33785
- Clevenger, C. K., Chu, T. A., Yang, Z. and Hepburn, K. W. (2012). Clinical care of persons with dementia in the emergency department: a review of the literature and agenda for research. Journal of the American Geriatrics Society, 60(9), 1742-1748. http://dx.doi.org/10.1111/j.1532-5415.2012.04108.x
- Gray, L. C., Peel, N. M., Costa, A. P., Burkett, E., Dey, A.B., Jonsson, P. V., Lakhan, P., Ljunggren, G., Sjrostrand, F., Swoboda, W., Wellens, N. I. H. and Hirdes, J. (2013). Profiles of Older Patients in the Emergency Department: Findings From the interRAI Multinational emergency Department Study. Annals of Emergency Medecine, 62(5), 467-474. http://dx.doi.org/10.1016/j.annemergmed.2013.05.008
- Samaras, N., Chevalley, T., Samaras, D. and Gold, G. (2010). Older patients in the emergency department: a review. Annals of Emergency Medicine, 56(3), 261-269. http://dx.doi.org/10.1016/j.annemergmed.2010.04.015
- Sampson, E. L., Blanchard, M. R., Jones, L., Tookman, A. and King, M. (2009). Dementia in the acute hospital: prospective cohort study of prevalence and mortality. The British Journal of Psychiatry, 195(1), 61-66. http://dx.doi.org/10.1192/bjp.bp.108.055335
- Thompson, K. & Allen, S.C. (2013). Outcomes of emergency admission of older patients: impact of cognitive impairment. British Journal of Hospital Medicine, 69(6), 320-323. http://dx.doi.org/10.12968/hmed.2008.69.6.29619
In her M.Sc. thesis, Julia Robitaille assessed functional abilities in a sample of seniors with cognitive impairment who visited the emergency department — using the FSAS-ED tool — in order to explore the role of occupational therapists’ in multidisciplinary teams.
- Robitaille, J. (2013). L’évaluation du statut fonctionnel à l’urgence de la personne âgée ayant des troubles cognitifs : Un prédicteur de l’orientation à la sortie ? (M.Sc. thesis, Université Laval). Retrieved from www.theses.ulaval.ca/2013/29916/29916.pdf
You can also click on the following link to view the poster presented at the Canadian Association of Occupational Therapy Conference in Victoria in 2013:
- Robitaille, J., Veillette, N. et Freeman, A. (2013, May-June). Functional assessment of older people with cognitive disabilities in emergency. Poster presented at the CAOT conference, Victoria.