Therapy service in the emergency department

A central London hospital and major trauma centre has a proactive therapy service in the emergency department (ED).

It was set up in 1992 in response to the increasing number of patients requiring specialist therapy services. The aim of the service was to support early and timely discharges - thereby preventing unnecessary hospital stays or admission.

The service was initially developed and led by occupational therapists. It now includes physiotherapists working flexibly across professions within a skill-sharing approach.

The service offers a comprehensive therapy assessment at the earliest point in patients’ hospital journeys. This helps early discharge home from ED or the Clinical Decisions Unit (CDU).

A seven-day shift service from 8am to 6pm offers:

• upper limb fracture care, management and activities of daily living (ADL) retraining
• lower limb fracture or injury management, mobility aid provision and ADL retraining
• back and rib injury management, ADL retraining and advice
• therapy interventions for trauma and ‘silver (geriatric) trauma’
• functional assessments for those presenting with falls, frailty and general deterioration
• cognitive assessment for those presenting with mild head injury or concussion, delirium and other acute or chronic conditions - with necessary onward specialist navigation
• identifying and facilitating discharges via Discharge to Assess and Home First models of care - navigating a number of London boroughs
• mobility assessments - providing walking aid(s) for basic ADL equipment from onsite team equipment stock
• escalation of deteriorating patients

The team works in ED (minors, majors and resuscitation, Urgent Care Centre, Ambulatory Emergency Care and CDU). The service also covers Acute Medical Admissions wards. The team will accept referral based on the functional need/changes with the aim to prevent an unnecessary hospital stay.