Occupational Therapy and Physiotherapy join the ED

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					    Let’s Get Up and Go:
     A Physiotherapy and
Occupational Therapy ED Service

    Katie Kyle, Physiotherapy Coordinator
 Kate Coghlan, Senior Occupational Therapist

           Emergency Department
   Sir Charles Gairdner Hospital, Perth, WA
   Background to Initiative
606 beds

2005/06
47,150 ED presentations
47% patients admitted

10% ⇑ in ED presentations
each year

32% ED presentations >65yrs
  Prior to January 2005 …

Social Work

Nurse Discharge Coordinators

DEED Program
                    Service Evolution
                                                       Permanent funding
                                                        secured and Care
                                                       Coordination Team
                                                         formed (Dec ‘05)


                                    ED Project Extension
                                                (Sep ‘05)



                     ED Falls Team Project
                                 (May ‘05)

        Dedicated OT and PT
           Trial with existing
          services (Jan ‘05)

Self Funded OT
and PT Trials in
     ED (<2005)
The Care Coordination Team
Target ED Patient Groups
    The OT/ Physio Team

Dedicated group of
experienced therapists

7 day service

0800 - 2100 hrs

Interdisciplinary
          Service Objectives
Provide quality assessment and intervention to
facilitate safe and effective patient discharge

Prevent unnecessary and/ or inappropriate hospital
admissions

Commence early intervention for patients requiring
admission

Collaborate with community and hospital outreach
services
           Patient Referral Procedure

Referral received or    Liaise with Nurse or      Patient subjective     Tests/investigations
 initiated through        Doctor to obtain           assessment           commenced +/-
        EDIS            further information          commenced           analgesia initiated



Team decision made                               Functional assessment
                        Feedback to Doctor                               Feedback to Doctor
around appropriate                                 and intervention
                            and Nurse                                        and Nurse
 patient disposition                                   completed




Arrangements made
 and confirmed for          Patient leaves ED!
 next step of pt care
Assessment
  Personal Care
   Personal Care

  Bed Mobility
   Bed Mobility

    Transfers
     Transfers

    Mobility
    Mobility

    Function
     Function

     Social
      Social
             Intervention


                            Upper Limb Care
                             Upper Limb Care




Splinting
 Splinting
Education




     Falls Prevention
      Falls Prevention
        Education
         Education
Equipment Provision
  Follow Up




OT Assessment at the Falls Clinic
OT Assessment at the Falls Clinic
Resource Tool Development

Assessment proformas
Policy and Procedure
manual
Resource development -
referral and handouts
Falls packages
Aged care screening tool
(Older Persons Initiative)
            Outcomes
Timeframe: July 2006 - February 2007
Data Capture: EDIS and Microsoft Excel
KPIs:   Total patients seen/month
        Patients by AHS program
        “Other” patient program group
        Admits & D/Cs by AHS program
        Monthly readmissions (< 48 hrs)
        Delays from consult to time seen
Staff satisfaction survey results
                                     Total Patients Seen

                            Total Patients Seen July 2006 - February 2007
Number of Patients Seen




                          400
                          350
                          300
                          250
                          200                                                                                    366
                          150               306        314            319           334        323                                  332
                                                                                                                                                271
                          100
                           50
                            0
                                            6              6              6          6             6             6                  7            7
                                      l-0             -0             -0          t -0         -0            -0               n-
                                                                                                                                0              -0
                                J   u
                                                A   ug         S   ep         Oc         N ov          D ec            J   a            Fe
                                                                                                                                             b

                                                                              Months of the Year
               Patients by AHS Program

                               Patient Populations by AHS Program

                     180
                     160
Number of Patients




                     140
                     120                                             Falls
                     100                                             Back Pain
                      80                                             Respiratory
                      60                                             Other Code
                      40
                      20
                       0
                           Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb-
                            06   06   06   06   06   06   07   07
                                     Months of the Year
“Other” Patient Group
  Average Number of "Other" Patients Seen
       July 06 - February 07 (N = 1491)
                                  Fractures
                Unw ell
                                     8%
                 21%

    Inflammatory
      Conditions
         3%
                                               Musculoskeletal
 Psychiatric
                                                   30%
    1%

    Alcohol
      3%

      Cardiac
        7%

         Collapse         Neuro       Acopia
           5%              15%         7%
Overall Admissions and
     Discharges
       Number of Admissions and Discharges from
               July 2006 - February 2007
                     400
Number of Patients




                     350
                     300
                     250
                     200                            Discharges
                     150                            Admissions
                     100
                      50
                       0
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                               Months of the Year
Falls Program Admission Rate

                         Fallers Admission Rate 2004 -2006

              80
              70
              60
 % Admitted




              50                                                   2004
              40                                                   2005
              30                                                   2006
              20
              10
               0
                   May    June      Jul     Aug       Sep    Oct
                                 Months of the Year
   Back Pain Admissions

         Total     General  Neurosurgery/
       Back Pain   Medicine  Orthopaedic
       Admissions Admissions Admissions

2004     34%        22%          12%


2005     20%        11%          9%
Readmissions (<48hrs)/Month

                   Number of Representations with Same Diagnosis
                     to SCGH ED from July 2006 - February 2007
                   6
 Representations




                   5
   Number of




                   4
                   3
                   2
                   1
                   0
                       Jul-06 Aug- Sep-   Oct-   Nov-   Dec-   Jan-   Feb-
                               06   06     06     06     06     07     07
                                    Months of the Year
ED Staff Satisfaction Survey
Medical staff (n=20)
Nursing staff (n=27)
First performed in 2005 and repeated in 2006
100% response rate
85%    100% satisfaction with overall team
performance
60%     90% value OT /PT input for falls patients
45%     80% value OT/PT assistance in planning
discharge or admission/transfers
         Survey Comments
“Brilliant service, friendly and approachable staff, great
to have as part of our team.”

“Excellent service, very approachable. Is it possible to
have an on call service overnight ?”

“Try and maintain their excellent enthusiasm to see
patients! Don’t burn out!”

“Extremely valuable and efficient service, very keen and
helpful people.”
 Key Success Factors and
     Lessons Learnt
Planning and preparation
Hand-picking the team!
Evidenced-based assessment tools
Data Collection … Yes, it has to be done!
Importance of promotion and marketing
Leadership at all levels - Exec, Dept and
Team
Our Perfect Patient!