Seema Zerafa got involved with the Senior-Friendly ED initiative at Mount Sinai Hospital in Toronto when it was decided that a physiotherapist specialized in geriatric care was needed in the ED. Because Seema was already a part of the rehabilitation team, she got involved in this geriatric care plan automatically. There is a full-time occupational therapist and a full-time physiotherapist included in the ED budget. Their priority is in the emergency department but they also help the in-patient team when they are free.
Seema’s role is generally consulting along with the physiotherapist – they work as a team. The OT/PT team is mostly involved in the discharge planning when there is no medical need for the patient to remain in the hospital. They sort out what kind of disposition is appropriate for the patient, for example: equipment needs at home, more community services, or most importantly rehabilitation facilities application. The OT role in the rehab application is to evaluate and comment on the patient’s cognition, ADLs abilities and clarify the goal and outcomes desired after a rehab stay.
“The strength of our team really comes from the fact that we have a group of very skilled professionals who have certainly their own specific area of expertise but also common area where we can overlap with each other”.
At times, when there is excessive work for one or the other, they can fill in for each other. For example, she can do the cognitive assessment if the GEM nurse is too busy, or she can focus more on the functional evaluation if the physiotherapist is not available. “We help each other.”
Seema says the goal of the OT/PT team is “optimizing safety and maintain or restore function if possible. We try to optimize a person’s ability to continue to live independently or ensure that they can transition into a more appropriate environment”.
There is a real value to have an allied health team of the emergency department including OT, PT, social worker, GEM nurse and a CCAC care coordinator. When reflecting on the team she noted: “with the years, we realized that trying to do something early on really helps in the long run. If an admission can be avoided, if people can go home from the emergency department without having to go through the whole hospital process, if we can facilitate that transition, it is beneficial for the patient”.
An OT/PT Success Story
This is a success story of the OT/PT team in our emergency department:
“This is sort of a joint venture between me and the physiotherapist. This person was most likely to require a long term care transition because she had a significant decline in the last several months and things were getting worse. She had a previous failed attempt in a rehabilitation facility because she could not participate or manage well. And for whatever reason, she responded very well to our interactions. We figured out some psychiatric issues that she was dealing with and we got to the bottom of the problem why her functional status was so poor. Our strategies, technics and communication skills were able to solve this complicated multifactorial problem. She was sent to another rehabilitation facility and we were able to put off long term care for a little while longer”.
Future consideration for her role would be to have a constant presence in the emergency department in order to get more cognitive and functional screening, delirium prevention and facilitated transition of care. As of now, the OT/PT team is paged when relevant cases are in the ED, and the ED is given priority.