Emergency Departments and Occupational Therapy: Integration, Unscheduled Care and Over-crowding

Abstract

Introduction: Globally, over-crowding within Emergency Departments is becoming a serious concern (Walker et al 2016) impacting on patient safety (Pines et al 2011) and work-related stress (The College of Emergency Medicine 2013; Lavoie et al 2011). One reason for over-crowding is that, in addition to treating urgent medical and surgical conditions, Emergency Departments act as the ‘front doors’ of hospitals, and people wait for admission to acute-care (Walker et al 2016), a process known as unscheduled care (The Royal College of General Practitioners 2011). Occupational therapists are well-placed to address some of the issues around unscheduled care (Mearns et al 2008). This is because they assess and treat people directly in the Emergency Department and determine whether a discharge directly home is feasible (Mearns et al 2008). The College of Occupational Therapists recently claimed that 70% of patients referred to occupational therapy in this way were discharged directly (College of Occupational Therapists 2016). This presentation claims a role for occupational therapists in Emergency Departments in terms of their potential to reduce over-crowding. It will report on the findings from two linked studies: - a critical review of the literature (James et al 2016) and a qualitative study (James et al 2016a). Methods: A systematic search was performed for occupational therapy in the Emergency Department using database platforms, internet search engines and grey sources. Critical analysis of each record was undertaken and synthesised. An Interpretative Phenomenological Analysis framework was applied to the qualitative study. Nine occupational therapists with experience of working in the Emergency Departments were recruited from across Scotland. Individual, semi-structured interviews were audio-recorded and transcribed verbatim. Interview transcripts were analysed line-by-line and interpreted using Interpretative Phenomenological Analysis methods. Results: The systematic search returned 23 potentially relevant papers of which 16 met the criteria for further inclusion and seven were critically analysed. Not all study sample sizes were small, but variable methodological quality meant current evidence can only be taken into professional practice with caution. Findings from the qualitative study led to two over-arching themes. Theme one captured the experience of occupational therapists working in Emergency Departments. Theme two encapsulated what it was like to enter and establish a new role. Discussion: There are good reasons why occupational therapists are well-placed to address issues of over crowding in the Emergency Department. However, based on current evidence, there can only be a limited understanding of its role and efficacy. There is a need for large-scale, well designed research studies of occupational therapy within emergency care.