Hand therapy direct from emergency referrals

Mrs Yvonne Fellner1

1Eastern Health, Box hill, Austraila


Maximizing efficiency in patient flow is essential for efficient use of limited resources in healthcare.  Occupational Therapists working in hand therapy at an acute hospital tested a new pathway for patients with simple hand injuries to be referred directly from the Emergency Department (ED) to Hand Therapy.


To evaluate whether direct referrals from ED to Hand Therapy without prior assessment at a plastics medical clinic for patients with specific hand injuries could reduce patient waiting times without adversely affecting satisfaction or patient care.


A prospective pre and post intervention study was conducted with 50 patients presenting to ED with a range of defined, uncomplicated hand injuries.

The pre-intervention group was referred as usual practice from the ED to a Plastics outpatient clinic, where they were seen by a doctor followed by a hand therapist.

The post- intervention groups were referred directly to Hand Therapy from ED without attending the outpatient clinic.  Standard ongoing Hand Therapy intervention was the same for both groups.


The number of days from ED presentation to first specialty review (Hand Therapy or medical) reduced from 6.2 days to 2.7days with the new model, without adversely affecting   functional outcome, patient satisfaction or complication rates.


The development and implementation of a pathway for direct referral from the ED to Hand Therapy can reduce medical staff workload and patient waiting times, while maintaining functional outcomes.