Avoiding hospital admissions through the extended role of the occupational therapist

Objectives: The Australian state of Tasmania has seen a spike in Emergency Department presentations in recent years, particularly among the elderly. The University of Tasmania’s Tasmanian School of Medicine collaborated with the Tasmanian Health Service (THS) to evaluate a novel extended scope of Occupational Therapy (ESOT) service aimed at supporting hospital avoidance. The ESOT service was implemented in January 2018 as a trial within the THS’s existing OT service. Patients were referred to the ESOT service by other services after being assessed as having a high risk of imminent hospital presentation. OTs provided interventions related to falls, mobility, nutrition, support service coordination, and provided onward referrals to other services. This study aimed to evaluate the utility of the ESOT service, and to determine the value of the ESOT service to clients, caregivers, referrers, and the THS.

Methods: A convergent parallel mixed methods design was used to evaluate the ESOT intervention. This design was chosen to enable triangulation of data from different perspectives, and to validate the findings generated by each method through evidence produced by the other. Two sources of quantitative data, namely i) routinely collected organisational data and ii) a purpose-built survey of referring clinicians was used alongside qualitative data from semi-structured interviews (n=12) with patients and their carers.

Results: A total of 104 extended scope interventions were provided to 100 eligible clients, of which falls education and equipment/small aids were the most common. Most clients were able to stay at home. Clients in the highest priority triage category were responded to within the appropriate timeframe in 95% of cases. At least three quarters of referring clinicians who responded to our survey either agreed or strongly agreed to statements supporting the timeliness, utility, and ease of use of the ESOT service. Four global themes emerged from the qualitative data: staying at home is preferred, preventing falls through tools, increased health through service provision and feeling important.

Conclusions:Co-evaluation of the ESOT service from the perspective of the health service, referring clinicians, clients and their caregivers has shown that there is a need for the care provided by this service. The ESOT interventions contributed to hospital avoidance, making a positive impact on the lives of clients and their carers benefiting clients and healthcare organisations. Considering extended scope roles for OTs and alternative ways of delivering care in resource poor health services will help to create a more efficient and sustainable healthcare system.