By: Élise Robillard, Communications Advisor at Hôpital Montfort. ​

Since September 2024, the emergency department (ED) at Hôpital Montfort has welcomed a new and innovative team member: an occupational therapist dedicated exclusively to the ED. Her primary objective is to support safe discharges and help reduce unnecessary hospital admissions — and the results have been remarkable.

Meet Sandra Rego Branco, an occupational therapist at Montfort since 2012. After working in several units across the organization, Sandra has been embedded in the ED for the past 18 months, four days a week.

“Initially, my goal was to prevent one in four patients I assessed from being admitted to the hospital,” Sandra explains.

She has far exceeded that target. Since the program began, 80% of the admissions initially anticipated have been avoided — representing 255 patients who were able to return home safely with the right supports in place. 

Montfort is currently the only hospital in Ottawa to have implemented such a model in its ED. The success of the program has already sparked interest, with other hospitals in the region exploring how a similar approach could be integrated into their own emergency care models. 

“The idea had been taking shape shortly before Sandra started in this role,” says Manon Crevier, Manager of Therapeutic Services. “We explored a few different options, including having either an occupational therapist or a physiotherapist in the ED. Ultimately, we determined that the occupational therapist’s scope of practice was better suited to the ED environment, as it addresses a broader range of patient needs and challenges.”

“My field allows me to address a wide spectrum of issues,” Sandra adds. “As an occupational therapist, I can assess physical abilities such as mobility, stairs, balance, and strength, but also cognition and the need for home care services. My assessments are client-centred and holistic.” 

While a key objective of the role is to prevent admissions, the ED occupational therapist also plays an important role in supporting patients who do require hospitalization by facilitating smoother transitions to inpatient units. 

“The occupational therapist is a major asset in the emergency department,” says Manon. “She conducts comprehensive assessments and follow-ups to help prevent admissions, but she also supports patients who are admitted. By starting the assessment process in the ED, she can guide next steps and advise colleagues in inpatient units. Our vision was always about transitions — helping patients return home safely with the right services or ensuring continuity of care when admission is necessary.” 

The occupational therapist typically becomes involved midway through a patient’s ED journey, once a physician has confirmed that the patient is medically stable. At that point, Sandra conducts her assessment and works with the care team to determine the safest next steps. 

Her most common cases include patients experiencing decreased balance or general weakness, those who have fallen, or individuals who are losing independence.

“Sometimes the issue is caregiver burden,” she explains. “The patient requires more support than the caregiver can reasonably provide. I also frequently see orthopedic cases, such as ankle or upper‑limb fractures, and patients who need education related to pain management. I can quickly identify patients with risks related to wounds and initiate appropriate positioning. A significant part of my role is educating patients and families to help optimize their daily functioning at home.” 

What Sandra values most about her role in the ED is the pace — and the opportunity to truly focus on each patient. 

“I actually have more time with my patients here than I did on inpatient units,” she says. “My attention isn’t as divided by other unit-based tasks, and my interactions are more meaningful. Collaboration is also essential. I work closely with a social worker, a geriatric nurse, and a care coordinator from Ontario Health atHome. We support one another constantly, and I couldn’t do this work without them.” 

The appreciation for this role extends well beyond Sandra herself. In a survey of ED staff, 74% of respondents reported being very satisfied with the program. The most frequent comment: a desire to have an occupational therapist present in the ED at all times. 

This pilot program has demonstrated that the occupational therapist’s role is exceptionally well suited to the ED setting — whether to prevent admissions, support smoother transitions for admitted patients, or, most importantly, enhance the quality of care for emergency patients. Because when patients return home with tailored advice and practical guidance from a qualified professional, everyone benefits. ​