A Day in the Life of an Acute Care OT
When I first became an OT, I spent the first year and a half of my career working solely in inpatient rehab, and during that experience I wrote a post about what a typical inpatient rehab day looks like for me.
After that first year and a half, I began cross-training and then floating regularly to my hospital’s acute care side, and I immediately fell in love with the setting.
My time in acute care has been such a great learning experience, so I decided to share share what a typical day is like for me in this setting for anyone interested in trying out acute care.
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The Start of the Day
Working in my acute care unit is more flexible than inpatient rehab with start times since we don’t have set start times with patients. Even so, I try to get to work between 7:30-8:00 am so I can get most of my evaluations done in the morning.
Once I come in, I look at our scheduling board and write down all of my evaluations and treatments for the day. Evaluations have to be completed (or attempted) within 24 hours of receiving the order, which is often from the afternoon before.
Because of this, I chart review each evaluation (and some treatments if I have time) for the first 45 minutes to an hour in preparation for seeing them in the morning.
I check every patient’s history & physical, vital signs, lab values, nurse’s notes, and any other therapy or doctor’s notes to get as much information as I can before seeing the patient.
My Mid-Morning “Rush” for Completing Evals
After I finish my chart reviewing, I check in with the nurse treating each patient to make sure there isn’t anything else going on with them that isn’t yet in the chart. Once given the all-clear, I try my best to see as many evaluations as I can before lunch.
In my setting, I get anywhere from 3-7 evals for the day. If I have only evals and no treatments, I may complete some of them in the afternoon as well.
Evals can take between 15-30 minutes in general (not including documenting), so from 8:30-12:00ish I go from patient to patient. I will sometimes stop around 11:30 to document as much as I can until about 12:30 pm.
I do my best to get all or most of my evals done in the morning, and I try to maximize my morning as much as I can since I often get fewer units in the afternoon due to patient procedures and refusals later in the day (I also have way more energy before lunch!)
Unlike my inpatient rehab position, all of the documenting is on computers versus paper notes. Since I can’t eat and be on a computer, I do not document over my lunch period.
I find that with the craziness of running from unit to unit doing as much as I can in the morning, I need a mental breather anyway and enjoy eating and taking a break with my coworkers.
I usually try to take time from 12:30-1:00 to just eat and chill out, but of course there are some days where I have to take a later lunch to stay on track if the morning was crazy.
After Lunch: More Documentation Time
After lunch, we all disperse and try to find an open computer. Post-lunch I try to get all of my evals and treatments written up.
I always make it a point to get my morning notes done before going back to treating for the afternoon. This is not only to make sure I’m less overwhelmed at the end of the day, but also so I remember more details about the patients I saw in the morning.
After finishing my notes, I’ll review charts for my afternoon treatments and other evals I may have left. I used to review all the charts first thing in the morning, but I found that a lot can change from 7:30 am to 2:00 pm. Patients may also have discharged, so it can be time wasted looking everyone up in the morning.
Back to the Floor I Go
After getting my paperwork done, I’ll go back to the units I’m assigned to and check with nursing again for anyone I’m seeing. I’ll spend the next hour and a half to two hours seeing any evals I have left as well as my prioritized treatments (patients that have already been evaluated and are on our caseload).
If the afternoon is less than predictable, such as the patients are completing procedures, refusing therapy, or have been discharged, and I don’t have enough treatments or evals to fill my time from 2:00-3:30, I’ll text out to other OTs to see if they have anyone they can’t get to.
Depending on how much time I have, I’ll pick up a few more treatments or another eval that may have just come through.
What a Typical Acute Care Treatment Looks Like
Treatments in the acute care setting are a bit different than inpatient rehab. Acute care treatment times are shorter (generally only 30 minutes) and we do not have a gym to bring patients to. We also have to carry everything with us, so there is less equipment involved.
I look up the patients’ goals and needs beforehand, and bring the essentials that they may need, such as a hip kit or home exercise program. I also try to keep these must-haves with me to stay prepared.
I try to do a lot of ADL retraining and out of bed functional mobility, moreso than arm exercises since our patients typically are only mobilizing with therapy.
Depending on the patients’ needs (and wants), a treatment could be as low level as sitting edge of bed with max assist for a few minutes in preparation for ADLs, or it could be as high level as ambulating to the linen cart or bathroom and completing multiple toilet sit to stands or full bathing in standing.
I also try to include brushing teeth (in standing at the sink when possible) since patients hardly ever get set up for this with nursing. People really appreciate being able to brush their teeth in the hospital.
I’ve learned that with acute care treatments, you definitely learn to get creative with the limited time and resources.
Wrapping Up the Day
Once I have about an hour of the day left, I try to focus on wrapping up my last treatments so I can have time to get my notes done without staying late.
The day in acute care can easily become a huge vortex of time lost due to how fast-paced it is, so it’s good to give yourself time throughout the day to document. It’s also much more manageable to document throughout the day instead of trying to cram it all for the end.
Once I’m finished with everything, I head back to the scheduling board and prioritize my patients on the scheduling board for the next day’s treatments.
And finally, I write down my charges and units and add up my productivity, hoping I made it, but of course days can be higher or lower due to the sometimes crazy nature of acute care.
And there you have it, a typical (although I would not call acute care typical!) day in the life of an acute care OT.
Hopefully this gave you a bit of a feel for this fast paced but never boring setting!
If you’re about to start working or training in acute care, be sure to check out our Occupational Therapy Intervention in Acute Care e-book (linked below) to help you prepare and help you get through your acute care days as smoothly as possible.
How many patients in total are/were you required to see in Acute Care?
Hi Tracie, every hospital is a little different with their requirements, but where I currently work, we are encouraged to see 7-9 patients per day. I typically average 7 patients per day which is manageable for me.
Does your acute care require you to write discharge notes on all of your patients. I see lots of hospitals vary, and can not find clarification on requirements anywhere. From Minnesota.
Hi George, every hospital is different with their requirements, but for two of my acute care positions, we only write DC summaries if we are discharging them while they are still in the hospital but no longer need OT services. If they discharged from acute care while still in our plan of care, we do not need to write DC summaries, but again this will vary from hospital to hospital.
Hi, I was wondering if you had an example of what a clients chart looks like? Im getting close to going on my acute care rotation and am curious on how much information I need to filter through so I can prepare myself.
The charts are often pretty extensive and can vary quite a bit from system to system, but once you start your rotation your CI will definitely show you the important parts to look at. Good luck!
Hi, I am a COTA who has worked with pediatric patients in clinic, home and schools for the last 3 years. I am looking for a change of pace and with population, does anyone have any suggestions on how I can go about transitioning? It would be a huge learning curve for me as well since I have been working with kids for a really long time. Any suggestions or tips are welcome!
I either want to transition populations or go back for my masters or doctorate in OT.
I’ll be publishing a series on transitioning from adults to peds shortly but a lot of the information will also be helpful for the reverse situation. The first thing I recommend is to find some adult-based therapists to shadow and to start taking continuing education now, which you can add to your resume. I’ll be emailing out the series so be on the lookout for that 🙂