FEATURE CRITICAL CARE
Collaborative working in critical care
Occupational therapists Sophie Graves and Catrina Wigmore , from two different acute hospitals in East Anglia , explore their experience of a three-month secondment working collaboratively on a specialist cardiothoracic critical care unit
The Intensive Care Society ( 2019 ) guidelines
for the provision of intensive care services , identify the need for an occupational therapy service on intensive care . This service is required to provide early assessment and intervention , addressing a patient ’ s physical and cognitive rehabilitation needs , alongside encouragement to participate in meaningful functional activity .
While at the present time , understanding and evidence of the acute and long-term symptoms and impairments experienced by people recovering from COVID-19 are still emerging ( RCOT 2020 ), the requirement for occupational therapists on critical care has become ever more apparent .
Due to the increased profile of occupational therapists on critical care , a need was identified by the therapy team at the Royal Papworth Hospital . Amil Magpantay , deputy team lead occupational therapist , had already started to explore the role prior to the pandemic , but his ability to continue this had become restricted due to staff shielding and ward pressures .
The AHP lead , Pippa Hales , and occupational therapy team lead , Amy Chadwick , had the innovative idea of offering a three-month occupational therapist secondment . They contacted local hospitals , offering the opportunity for occupational therapists to gain experience of ECMO ( extracorporeal life support ), cardiothoracic equipment and hyper-acute rehabilitation on critical care .
As senior occupational therapists from busy district hospitals , we have had some experience working on critical care and had been offered the opportunity to further develop these services in our own trusts .
In order to do this , we identified the need to advance our knowledge and explore the occupational therapy role . This secondment , therefore , gave us the opportunity to work collaboratively with occupational therapists from other trusts and to increase our experience of working in a critical care environment , without the additional demands of discharge planning priorities .
We were made to feel very welcome by the occupational therapy team at the Royal Papworth Hospital . After the initial experience of getting used to a new place of work , we were able to establish how the current service was provided , including referrals , interventions and handovers to ward staff .
We observed that referrals were being made by the wider multidisciplinary team , but these lacked clarity as to the reason for referral and demonstrated that education of the occupational therapy role would be required .
We therefore felt it was best to initially screen all patients on the unit to ensure that patients requiring occupational therapy assessment were not missed .
This brought its own challenges , due to the size of the critical care unit . Having both come from small units with a maximum of 16 beds , screening up to 32 patients daily was no mean feat .
We determined that moving forward a referral criteria would need to be established , which could then be introduced to the wider multidisciplinary team , providing guidance for referring patients .
32 OTnews January 2021