Occupational Therapy’s Role in Inpatient Settings

As an occupational therapy student, I remember being completely overwhelmed by all the different practice settings where an OT can work. In particular, I had trouble discerning between inpatient hospitals (also known as acute care hospitals) and acute rehab hospitals. In my head, I used those words interchangeably until I finally learned more detail behind each setting.

Therapists in these roles do have a lot of overlap simply because they are both hospital-based. An OT in an inpatient/acute care hospital will work with patients who have short lengths of stay due to acute health concerns.

As a result, therapists will usually work with a patient for 3-5 days (sometimes even less) before they are discharged to their home. Therapists working in acute care departments are very swift and to-the-point in the work they do with patients. Occupational therapy’s role in acute care also includes:

Assessing Safety in Preparation for Discharge

Patients will either go to their home, short term rehab, or back to a long-term care facility where they reside. This means therapists will make recommendations for a patient’s level of care upon discharge, including notifying other team members such as care coordinators and social workers of a major change in status due to the patient’s hospitalization/medical concerns; therapists may recommend that patient have stand-by assist during ADLs, 24/7 care due to unsafe behaviors, or anything in between.

Resumption of Daily Activities

While OTs in this setting do not usually have enough time in the plan of care to focus on IADLs or leisure, they do help patients get started on returning to their previous level of functioning as it pertains to self-care and ADLs; this is crucial because patients will need this jump start on rehabilitation whether they are transferred to a short-term rehab facility before going home or they return directly to their home and begin home care or outpatient services.

Ordering Durable Medical Equipment (DME)

Some patients may not need much rehabilitation following short hospital stays, but a lot of people who are in the hospital for a brief period of time are those who recently had surgery or another medical procedure. As a result, they may need temporary assistance in the form of equipment such as 3-in-1 commodes, crutches, walkers, braces, orthoses, and more.

Other individuals, especially older adults, may experience a decline in overall health status due to an exacerbation of a chronic condition. In this case, such equipment may be more of a permanent accommodation.

Regardless of why (or how long) someone needs DME, such tools allow patients to remain as independent as possible while accommodating for their change in abilities. OTs in inpatient care settings do the foundational work early on to measure patients for this equipment and complete the relevant assessments to ensure they are a good fit.

Equipment is usually sent directly to the patient’s home and therapists or caregivers can assist with assembling it and making adjustments there. However, it’s crucial that therapists guarantee these tools are in the home before a patient gets there, since their release from the hospital is usually contingent on having a safe and accommodating place to return to.

Many of the job duties of an occupational therapist in acute rehabilitation are very similar to those associated with inpatient/acute care services. The main difference between these two settings is the length of time that patients are seen for. Most people in acute care are recommended to get a screening or evaluation to see if they may need occupational, physical, or speech therapy.

Sometimes they end up getting services and sometimes the screen shows they don’t need it. If they end up qualifying for services based on a medical need, they will usually get services three to five times per week until they are discharged.

What About Acute Rehab?

In acute rehab, patients must be recommended for these services while in acute care, since acute rehab is far more intense than other OT services. Sometimes this takes place in a separate part of a hospital with one part being acute care and another portion other dedicated to acute rehabilitation. Patients might even be transferred to a separate facility altogether that is only for acute rehabilitation.

This is called an inpatient rehabilitation facility (or IRF). Either way, someone qualifies for acute rehabilitation by being able to tolerate at least three hours of daily therapy five days per week. If they show a lot of progress and motivation for improvement, the rest of the treatment team will recommend them for acute rehab.

While in this program, they must continually make progress in order to remain at this level of care. Otherwise, they may be discharged to another type of short-term rehab such as a skilled nursing facility.

Common Diagnoses OTs in Inpatient Settings Will See

The Centers for Medicare and Medicaid Services have a list of qualifying diagnoses that at least 60% of acute rehabilitation patients must have in order for the facility to receive reimbursement. There are thirteen diagnoses that include:

• Congenital deformity
• Stroke
• Spinal cord injury
• Brain injury
• Amputation
• Major multiple trauma (MMT)
• Hip fracture
• Burns
• Some neurological conditions such as multiple sclerosis and Parkinson’s disease
• One of three types of arthritis that have not responded to outpatient therapy
• Bilateral hip or knee replacements in patients with a BMI > 50 or those who are over 85 years old

Common Interventions for Inpatient OTs

As you can see, there is quite a big difference between the intensity of these two practice settings. But the good news is that there is not much delineation between the types of treatment they provide. Therapists in both inpatient care settings and acute rehabilitation settings both engage patients in treatments that address:

• Balance
• Coordination
• Range of motion
• Transfers
• Bed mobility
• Self-care performance, including dressing, eating, toileting, bathing, and grooming
• Functional mobility

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If you are interested in working in one or both of these practice settings, it’s a great way to get a lot of experience with many diagnoses. Both of these inpatient settings see patients both old and young with chronic conditions and acute health issues, so you will be able to understand the impact that a variety of factors has on the rehabilitation process.

If you’ve shadowed or had a fieldwork rotation in one or both of these settings, what’s your favorite part about an OT’s role in inpatient? If you haven’t had experience in acute care or inpatient rehabilitation settings, do you think you’d like working in one? Let us know in the comments!