My practice

Enabling people to live in the community and prevent admission on
to a hospital ward poses all sorts of challenges for health and
social care professionals.

After many years of working in the community for social services, I
now work in an accident and emergency (A&E) department of an
acute hospital NHS Trust. On the face of it, the two jobs seem to
be at opposite ends of the spectrum but, for an occupational
therapist, they have much in common.

The aim of occupational therapy in A&E is to provide a rapid
response, preventing unnecessary social admissions to hospital by
enabling people to return home sooner to a safe environment. It may
include recommending a transfer to step-down or rehabilitation
beds, which are usually provided through a care manager.

Where someone simply needs equipment to enable them to manage again
at home, for example, a toilet frame or raising an armchair, this
can be organised immediately and the person can leave hospital
within hours.

When a patient is medically fit but unable to return home
independently, it is good practice to do a joint assessment with a
care manager. A co-ordinated discharge plan can be established and
equipment or adaptations can be arranged and a care package set
up.

Where it is established that someone cannot be discharged straight
home, but does not need to be admitted to an (expensive) acute bed,
they may be transferred to a step-down or intermediate care bed in
community resource centres.

In addition to the rapid occupational therapy assessment service, a
screening programme for people who have fallen down has been
developed across the acute trust and community and primary care
services. This involves more closely monitoring the people who
visit A&E after a fall and ensuring they are referred to the
best people to review possible causes of the incident. A medication
review may be sought, attendance at a multidisciplinary falls
prevention group at the day hospital may be recommended or referral
to community occupational therapists.

There is also development work to do on identifying people who
repeatedly use A&E and why that is, whether it is because of
inappropriate accommodation, insufficient social support or regular
falls. There is scope to develop follow-up services for people who
are admitted and quickly discharged outside occupational therapy
working hours, but would benefit from intervention.

With the target of every person attending A&E being seen,
diagnosed and treated within four hours, it is a challenge to sort
matters. It is important to understand how to access community
resources to facilitate a safe and effective discharge from an
acute hospital environment.

James Lampert is a senior occupational therapist at the Queen
Elizabeth the Queen Mother Hospital, Margate, East Kent Hospitals
NHS Trust.