Report by OT Award 2019 Winner Ann Drea Award Helps Avoid Hospital Admissions

Ann Drea, a band 6 locum occupational therapist working in a Pilot Front of House Team at Hinchingbrooke Hospital, was the proud winner of the Cosyfeet OT Award 2019. Her £1000 award money was used to purchase assessment equipment to facilitate a safe and speedy return home for clients. Here is Ann’s account of how the assessment equipment is being used to avoid hospital admissions.

The Front of House team operates a pilot frailty project and is part of the intermediate care tier of Cambridgeshire and Peterborough NHS Foundation Trust. This scheme runs within Hinchingbrooke hospital, receiving referrals from the Accident and Emergency Department (A&E), the Acute Assessment Unit (AAU) and the Fracture Clinic. The small team consists of occupational therapists and therapy assistants who work closely with multi-disciplinary teams (MDTs) within each of the above areas to assess persons who are medically fit for discharge but may have ongoing therapy needs. They may therefore require holistic social or health assessments to determine if we can facilitate a safe and timely discharge to their pre-admission destination.

The provision of equipment is a compensatory approach to support a person to execute daily functions that are currently challenging. This approach, when used in conjunction with education and therapy delivery, reassures the person and/or their care givers and enables them to be more accepting of support, if even for a temporary period, until they are at their baseline. The assessment stock, funded by the Cosyfeet OT Award, consists of essential items to best support a person at home and provides the FOH team with an immediate source of equipment for carrying out assessments. Appropriate items can then be ordered for swift delivery to a person’s home address. This also supports health and social care community teams, as necessary items are in situ, ready for their professional follow up intervention.

We are witnessing more and more ‘casual’ hospital attendances whereby no appointment is needed, for instance at A&E, which in turn puts a huge strain on such services (James et al 2016). A greater number of individuals aged over 65 now present with falls, lack of social input (“acopia”), increased confusion (often associated with a background of dementia), reduced mobility and unwell (“off legs”) and/or an exacerbation of a pre-existing long term condition such as chronic obstructive pulmonary disease (COPD). These are not usually life-threatening medical emergencies.

Ann Drea (centre) with OT Katy Daoud (left) and Clinical Lead Nicola Tatham (right)

The majority of our referrals are the older patient population who require more assessment time than other patients due to their complex comorbidities. This can lead to delays in discharge because of the time needed to explore the most appropriate discharge pathway. From a FOH therapy perspective, we can identify and assess those who have the potential for discharge back to their own homes to avoid unnecessary admission onto an acute ward, and so reduce bed-days.

FOH use a non-standardised form of assessment referred to as a My Discharge Plan. This paperwork accompanies the individual whilst in hospital. The findings of the MDP often involve:
(i) further therapy input across general physical and cognitive functioning to enable the person to return to their baseline.
(ii) equipment needs in order to support a return to baseline and/or remain at their current baseline level.
(iii) requisitioning a suitable package of care (POC) and or social input.
(iv) actively referring to community services to support the individual’s discharge home e.g. community therapy, assistive technology, and/or:
(v) signposting to relevant services.

The role of therapy within the FOH service is broad as the assessment is a holistic picture, however, a key aspect of this involves assessing and identifying the need for equipment that may support the person to carry out their day-to-day activities independently. Experience shows that a “tell, do and show” approach instils greater understanding and willingness to engage. “I hear and I forget, I see and I remember, I do and I understand” (Confucius).

Examples of the use of assessment stock to supported individuals are as follows:

Karen, a 66-year-old lady, presented with bilateral ankle fractures following a fall. Her house has many internal steps. With advice on developing a micro home environment and the trial of a gutter frame and glide commode, Karen was enabled to get home and commence with bed-chair-commode (variation) transfers until review by the fracture clinic. This allowed her to stay within her own environment, supported by her partner, without the need for an overnight stay and/or an interim bed.

Steve, a 72-year-old gentleman, presented due to a fall when transferring from bed. Steve lives with his wife and has a substantial medical history but is a very independent man. He continues to master the stairs, has been struggling with bed and toilet transfers and has an unsteady gait with his stick. Prior to his fall Steve had been reluctant to have any equipment. After exploring identified aids for himself, including a bed handle, a wheeled Zimmer frame (WZF) and a free-standing toilet frame (FSTF), both he and his wife could see how they would help him to conserve energy and provide a means of remaining at home with a reduced risk of falls.

Mick, a 95-year-old gentleman, was referred from A&E to AAU due to a fall within the bathroom at home. Mick lives alone and remains independent with activities of daily living (ADLs) but experiences increased pain on movement. His baseline mobility is with a stick. Mick consented to explore the use of a WZF due to his unsteady presentation. He relies on armrests to support his STS (sit to stand). There was currently no frame around his toilet at home and he leaned heavily on a towel rail. He agreed to explore a FSTF to aid his transfers. After being able to try equipment out he consented to having a WZF and FSTF until he was stronger. He also agreed to involve community therapy follow-up to explore other concerns such as bathing transfers regarding falls prevention, and to maintain his independence.

Ann Drea with falls patient

Our new stock of demonstration equipment is vital as it avoids us having to rely on merely explaining it or having to hunt round inpatient rehab and/or wards to borrow it for demo purposes. Individuals can readily trial items for themselves, experience the likely benefit and go on to live more independently and more safely at home. It’s a “win win” situation for the people we see, who simply want to return home, and for the hospital, where the goal is to avoid all but acute admissions.

James, K., Jones, D., Kempenaar, L., Preston, J., and Kerr, S., (2016) Occupational therapy and emergency departments: A critical review of the literature. British Journal of Occupational Therapy 79(8) 459-466