A review of the effective management at the Paediatric Emergency Department at St. Luke's Hospital.

Abstract

Due to the dramatic increase in individuals aged sixty and over it is imperative that they remain as independent as possible and still give an effective contribution to society. The focus lies in the quality of life rather than longevity on its own. While the importance of physiotherapy in prevention and rehabilitation has been widely recognized, Community Physiotherapy Services (CPS) for older people might help identify problems early on and hinder a chain reaction of multiple complications which might lead to decreased independence and eventual institutionalisation. Furthermore the Maltese healthcare system encourages people to be institutionalised who really do not need to be admitted to a residential home due to the gap in service provision. Since CPS is not yet available in Malta the purpose of this study is to assess the need for setting up such a service. Methodology: Due to the complexity of the issues under study, both qualitative and quantitative measures were used by collecting original information and adapting what was already available as suggested by Wright, Williams & Wilkinson (1998). A self-administered questionnaire was distributed to physiotherapists (N=99) working with the Ministry of Health, Elderly and Community Care. Analysis of application forms of St Vincent De Paul Residence (SVPR) between 1999 and 2005 (N=332) was also carried. From the application forms between 2003 and 2005 (N=152), 55 older people accepted to take part in a structured interview and mobility assessment. A semi-structured interview was also carried out with key persons who can play an important role in the implication or not of CPS. From personal communication with physiotherapists responsible from Physiotherapy Units or Departments, information about the present physiotherapy services for the older people obtained. Also through analysis of data obtained from records of the Physiotherapy Department of St Luke's Hospital (SLH), the average ages of the patients referred for physiotherapy was determined. Results & Discussion: Both Physiotherapists and key persons recognised the importance of CPS especially in enabling early discharge from hospital and in preventing early institutionalisation. While they acknowledged the important role that physiotherapists play in rehabilitation of the older people, they agree that physiotherapists cannot work alone in the community but need to be part of the multi-disciplinary team. Older people did not feel the importance for CPS. This could be due to the lack of information and awareness about CPS. In fact decreased awareness of Community Services in general was also noticed. From the older people taking part in the interview, 39 (71 %) showed difficulties in carrying out activities especially during mobility. Also from the application of SVPR it was evident that the older people were stated to be suffering from a variety of limitations ranging from communication, mental, physical and social. Physiotherapists deemed those older people whose journey to hospital would have counteracted the affect of treatment, those whose family needed advice about handing techniques and those whose acute nature of the condition is better treated at home, to be the most eligible candidates for CPS. Physiotherapy Department responsible for the national provision of CPS was deemed to be most appropriate due to economical reasons. The need for adequate but not lengthy planning and the formation of operational guidelines both to help physiotherapists and to be used by managers were suggested. Requirements for implementation of CPS as suggested by participants included the need for motivated, mature and skilled physiotherapists, flexible working schedules, portable equipment and supplied transport modalities or adequate remuneration. Increased autonomy to physiotherapists, adequate promotion and increased awareness about physiotherapy and community services were suggested, especially to General Practitioners, to enable timely access to services. Conclusion: For the introduction of CPS to be carried out, support from the policy makers has to be obtained. Also changes will be required to accommodate the dynamic nature of CPS accompanied with a shift to primary health care. For this reason action research is deemed to be the next step forward.