Earlier therapy intervention in the emergency department to improve clinical outcomes for fallers aged 65 and over

Purpose

To improve clinical outcomes for fallers aged 65 and over presenting to the emergency department through earlier therapy intervention and multidisciplinary focussed assessments.

The intended benefits to the older person and service were for:

1. Older adult fallers to be referred more quickly for a therapy assessment.

2. Older adults to spend less time immobile on an emergency department trolley.

3. Timely multidisciplinary discharge plans being formulated in line with national guidelines.

4. Increased numbers of older adults receiving holistic comprehensive geriatric assessments.

120%
more adult fallers were seen in January 2019 compared to the previous year, and...
...58%
more fallers were seen in February 2019 compared to 2018.

Approach

The quality improvement project was carried out using the Plan, Do, Study, Act (PDSA) cycle.

Three iterative PDSA cycles were carried out over the course of the project to deliver simple, proactive interventions developed as a result of local baseline data analysis as well as stakeholder and root cause analysis. These interventions included therapists attending the daily clinical handover, therapists screening the electronic emergency department floor and training for the emergency department clinical team. All were aimed at increasing the visual presence of the therapy team within the emergency department.

Outcomes

The project resulted in an increased referral speed of fallers aged 65 and over for assessment, which led to increased numbers of older adult fallers receiving holistic, multidisciplinary assessments. 120% more adult fallers were seen in January 2019 compared to the previous year, and 58% more fallers were seen in February 2019 compared to 2018.

The earlier intervention by the therapy team also led to more older adults up and moving sooner, which had positive effects in terms of maintaining their dignity.

The quality improvement project found that more older adults aged 65 and over admitted to the emergency department with a fall can receive holistic, multidisciplinary assessments through the introduction of small, simple interventions aimed at increasing the proactivity and overall visual presence of the physiotherapy team.

The team are now more at the heart of the emergency department team and are providing care to a larger number of older adults, improving their functional independence, dignity and quality of life and giving them an overall more positive experience.

The ED model of care is traditionally nursing and medical led but what this improvement project shows it that it is essentially the collaborative nature of the multidisciplinary team that can lead to better clinical outcomes for older adults attending the emergency department.

Implications

The project highlights the adaptability of physiotherapy to the needs of older adult care and management and demonstrates that physiotherapists need to be proactive in the way referrals are received, based on our ability to be autonomous. It also highlights the change within healthcare away from the medical model to more holistic management and that physiotherapists need to put themselves into the heart of this and drive what we do through training and visual presence.

The project demonstrated the need for working practices to develop further around teamwork within the management of complex older adults who present with multi-morbidities, especially in areas that traditionally follow a more medical model such an the emergency department.

Funding acknowledgements

The work carried out was unfunded.

Additional notes

This work was presented at Physiotherapy UK 2019.