Read Full Text: Occupational therapists and paramedics form a mutually beneficial alliance to reduce the pressure on hospitals: A practice analysis (Paid article, but we thought it was important to cover)
Journal: British Journal of Occupational Therapy
Year Published: 2018
With racial injustice at the forefront of our national consciousness, many of us are learning that the very systems that keep our country running are directly contributing to racial inequities.
These systems need to change.
This week, we looked for an article that showcased how OT could be part of a new future that is more equitable.
While the article we found doesnât exactly provide a silver-bullet solution, I hope it does get you excited about new ways that we might be part of upstream solutions. After all, outdated and unjust systems permeate our hospitals, our schools, our prisons, and even our first responder crews.
This article examines a program in Scotland, where OTs and paramedics teamed up to create an alternative pathway of care to reduce hospital admissions.
Shifting our focus to keeping people out of the hospital in the first place
In the Club, weâve already discussed how OTs help reduce hospital readmissionsâand weâve also covered how post-hospital syndrome makes it critical that people stay in the hospital only when absolutely necessary.
But, there simply arenât enough OTs working to keep our clients out of the hospital in the first place.
Maybe now is the time to reimagine a new way of doing things!
As the article points out, emergency department (ED) visitors are often not dealing with life-threatening emergencies. Instead, people often go to the ED for non-emergency matters, such as:
- Relapses in chronic conditions
- Breakdowns in social care
- Function difficulties (such as decreased mobility)
While we can look at this list and easily see that these problems likely wouldnât be solved by an ED visit, most paramedics will automatically take patients to the ED by default.
This is where OT has the potential to lend our skillset. In the UK, evidence is already pointing to the value of occupational therapy working in partnership with emergency servicesânotably with fire and rescue. And, this article seeks to expand our role even further.
What was the aim of the particular practice analysis?
This paper reports on a structural learning program that was developed at an ambulance station in Scotland. In this program, OT professionals and paramedics worked together to learn about each otherâs respective skillsets and clinical reasoning, in an attempt to develop an alternative care pathway beyond sending patients to the hospital.
The process began with shadowing
To begin learning the process of developing an alternative care pathway, an OT rode along on two 12 hour shifts with an ambulance crew.
The OT and paramedics worked together to chart how many of the calls might have benefited from allied health interventions. They noted the cases where, had an allied health professional been involved, hospital admission might have been prevented (or the quality of life improved).
Notably, 23% of the calls potentially could have benefited from an allied health professional.
Next came awareness sessions
90-minute awareness sessions were then held for anyone who would be involved in the alternative care pathway. They were led by a team composed of:
- An OT
- A paramedic
- A falls coordinator
- A member of the integrated care and enablement team
The focus of the sessions was to develop a shared understanding of the need for a creative alternative to hospital admissions.
The session began with an overview of why a new pathway was needed, notably the negative impact hospital admissions have on vulnerable groups.
Next, a clinical decision algorithm was introduced to the existing framework used by paramedics. This new algorithm incorporated the direct referral to a multidisciplinary team, through a single point of contact.
Finally the group looked at two case studies and discussed how the new algorithm might play out in a real-life scenario.
5 months after the initial shadowing experience, the pilot program was launched
When the pilot program was launched, paramedics could contact a multidisciplinary team directly from the service-usersâ homes, and immediately make the appropriate referral.
One of the key success metrics they were looking for was the reduction of the current rate of being transferred to a hospital from 38% down to 25%.
In the first two weeks of the program, there was a median reduction from 38%-28%.
Takeaways for OT practitioners:
1. âNever doubt that a small group of thoughtful, committed citizens can change the world; Indeed, itâs the only thing that ever has.â âMargaret Mead
This article served as a good reminder for me about how change comes about, in our complex seemingly immovable systems. It usually involves a small group of individuals, who are willing to put in consistent work over months and years. There are lots of meetings. Time is taken to listen and work to get buy-in. And, outcomes are tracked. Sometimes, bringing about the seemingly radical change we want looks pretty boring 
Imagine if every OT was part of one such group seeking change. Imagine how much of a difference we could make as a profession over the next 5 years.
2. For some reason, our systems have evolved to focus on downstream problems. Itâs time to look upstream.
While this article did not speak specifically to racism and health inequities, it did speak to shifting the focus of our care more upstream. And, this is a consistent solution I see in almost every article reducing health inequalities.
Last week, @rebecca12 shared this amazing article on reducing racial inequalities in health. (I highly recommend reading it. As the author put it in the conclusion:
âInitiatives are required to shift the health care system from a narrow focus on treatment to emphasize preventing disease and providing timely, appropriate, high-quality care for all that is tailored to the culture and context of each patient.â
3. Those of us in the US may look at this program, scratch our heads, and ask, âWho would pay for this?â
For us in the US, it is really hard to imagine programs like the one mentioned above, because we seem so ingrained in our fee-for-service models. Simply put: why would our hospitals want to reduce admissions when that is how they make money??
I believe we will shift from fee-for-service care to value based care in our lifetime, because it makes more sense to pay for keeping people healthy.
Even though itâs hard to imagine how this change will ever come about, I feel confident it will be small groups of committed professionals, doing lots of seemingly boring work (meetings, task-forces, committees, outcome tracking, etc.) that will ultimately bring about this seismic shift.
(Possibly) Earn CEUs/PDUs for reading this article.
Many of you can receive continuing education credits for reading this article. Hereâs a form to help you do it, along with information to help you understand who qualifies.
And, hereâs the full APA citation you many need:
Preston, J., Galloway, M., Wilson, R., Mcnamee, L., Deans, Y., & Mcghee, G. (2018). Occupational therapists and paramedics form a mutually beneficial alliance to reduce the pressure on hospitals: A practice analysis. British Journal of Occupational Therapy, 81(6), 358â362. doi: 10.1177/0308022618757412
