Introduction of a 7/7 Physiotherapy Service to Older Adults in the Emergency Department: a 10 Month Review

Abstract Background The Physiotherapy Department in University Hospital Limerick (UHL) traditionally provided a 5-day service to older adults in the Emergency Department (ED). Prolonged exposure to the ED environment predisposes older adults to a range of adverse outcomes e.g. deconditioning, delirium, malnutrition. The ED provides an interdisciplinary service to older adults Monday-Friday, with a focus on early assessment and intervention. With reduced supports at weekends, research suggests patients are more likely to experience delayed discharges and adverse outcomes. Methods Since July 2024, a Physiotherapy-specific weekend service was introduced across the ED to facilitate same day assessment for discharge, reducing the risk of adverse outcomes for older adults at weekends. Physiotherapy staff were trained and upskilled by members of the ED physiotherapy team, and rostered on a voluntary basis. Data was collected inclusive of patient demographics, index presentations, patient outcomes, 30 day re-presentations and use of community services. Results 229 patients were seen over 42 weekends, averaging 5.5 patients/weekend. The mean(SD) age(years) was 80.6(9.75), with 55.5% female. >50% presented with falls or limb problems. The mean patient experience time(hours) was 27.35. 59.4% discharged home, 22.7% transferred to model 2 hospitals and 18% were admitted to UHL. 15.2% re-presented to ED within 30 days, 68.5% subsequently requiring an inpatient admission. 50 referrals were sent to community services. Qualitative feedback was sought from staff - all felt adequately prepared for weekend working, gained transferrable skills to working mid-week and felt the service was beneficial to patients. Following staff feedback, a workshop was delivered to facilitate case discussions and further skill development Conclusion The introduction of a 7/7 Physiotherapy service led to 136 older adults being discharged home over a 10-month period. Future developments include ongoing upskilling of staff, with further service expansion focusing on equity and parity in accessing services for older adults.