Mrs Melinda Williamson1,2, A/ Prof Kristie Harper1,2, Doctor Sarah Bernard1,2, Prof Courtenay Harris1
1Curtin University, Bentley, Australia, 2Sir Charles Gairdner Hospital, Nedlands, Australia
Biography:
Melinda Williamson is an ED occupational therapist with over 15 years’ experience, across Australia and UK. She is current a PhD candidate investigating the health and system outcome of an early allied health frailty service for older adults attending the ED.
Melinda has a passion for acute care of older adults attending the ED. Her research and publications have focused on the care of older adults in the ED, exploring falls guideline adherence, frailty identification and patient activation. Melinda worked with NHS England & NHS Improvement to create online frailty education programs for health and social care staff and caregivers.
Abstract:
Background:
Rising Emergency Department (ED) demand strains resources to assess and manage frail older adults. Allied health supports comprehensive care, disposition planning and patient safety in the ED but often intervenes late. This study investigated factors affecting allied health referrals and co-designed an early allied health frailty service.
Methods:
An explanatory sequential mixed-methods approach was used. Patient journey mapping of low acuity older ED patients was followed by stakeholder focus groups. Primary outcomes included time to doctor and allied health assessments and ED length of stay (LOS).
Results:
From triage, 20 patients waited a mean 110 minutes (SD 83 minutes) for doctor assessment, 123 minutes (SD 116 minutes) for ED bed and 355 minutes (SD 297 minutes) for allied health assessment, with mean ED length of stay 685 minutes (SD 444 minutes). Allied health discharged 47% (n=7) from their service. Ten (50%) missed usual medication prior to presenting and 30% (n=6) were prescribed their regular medications 341 minutes (SD 134 minutes) after arrival. Five (25%) did not received any food or fluids in. Qualitative analysis revealed benefits of early allied health included shorter LOS, earlier discharge plans, streamlined medical decisions and increased nurse confidence. Barriers included competing doctor and allied health assessment, limited space for assessment, and assessments prior to medical investigations. Tailored inclusion criteria and staff training were potential solutions.
Conclusion:
Allied health assessment occurred six hours post presentation, outside national targets. Opportunities and barriers identified supported the development of an earlier allied health frailty service.