“Occupational therapists help people to do the things they want to do”
In this month’s EMJ, Kirstin James details the work that occupational therapists (OTs) have been carrying out up and down the country’s emergency departments to facilitate a return to normality after an illness or injury. She tells the story of an 87 year old lady called Mrs MacDonald, well known in various guises throughout our profession, and how she assessed her physically, cognitively, and socially to determine her ongoing needs after a fall and humerus fracture. By carrying out her assessment and determining the patient’s needs, Kirstin could enable Mrs MacDonald to go home. She organised care visits by the crisis team whilst more permanent arrangements were being made, procured equipment to make it easier for Mrs MacDonald to get around the house and go to the toilet, and made sure she had the support she needed.
Kirstin made it possible for Mrs MacDonald to do the things she wanted to do, and to do them in her own home rather than a hospital bed.
Whilst my local ED doesn’t have direct occupational therapy input, we can admit patients to our observation unit to be assessed by a multidisciplinary team comprising of physiotherapists, OTs, and discharge co-ordinators who can facilitate access to community nursing and other services. Once they have been assessed, a decision can be made on whether the patient is safe to go home that day (with or without further assessment in the near future), or that they need measures put in place before they go home. Sometimes these measures take time and, after discussing it with the patient, it may be better for them to be admitted to one of the main hospital wards to allow this to take place.
Kirstin’s article is a fantastic reminder that our work in emergency medicine isn’t just about fixing a medical problem. We also have to consider the impact that this medical problem is going to have on our patient when they get home. Are they still going to be able to eat, drink, move around their house, go to the toilet? What help do they need to allow this to happen? Who else is, or can be, at home with them? Thinking about these issues early on may help the patient to get better more quickly, and avoid further ED attendances and subsequent hospital stays.
If you don’t know how to access occupational therapy in your ED, find out! And if you do know, let us know what happens where you are. We’d love to hear.
James K. Occupational therapists in Emergency Departments. Emerg Med J 2016;33:442-443.