I consider myself to have been pretty lucky entering the workforce as an occupational therapy new grad.
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.
For the past 6 months, I’ve also been learning the ins and outs of acute care as an OT.
When I heard of an opportunity to cross-train in acute care at my hospital, I jumped in head first ready to take on this new and exciting challenge.
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 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 huge scheduling board and write down my evaluations and treatments for the day. Evaluations have to be completed (or attempted) within 24 hours of receiving the order, which was usually from the afternoon before.
Because of this, I chart review each eval for the first half hour to 45 minutes 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 Evals
After I finish my chart reviewing, I check 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 in the day. If I have only evals and no treatments, I complete some of them in the afternoon as well.
Evals can take between 15-30 minutes in general (not including documenting), so from 9:00-11:00-ish I go from patient to patient. I stop around 11:00 to document as much as I can until about 12:15 pm.
I do my best to get more than 10 units in the morning, since my job requires 20 units a day to stay productive. I try to maximize my morning since I often get fewer units in the afternoon due to patient procedures and refusals later in the day.
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 typically 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 12:15-1:00 to just chill out, but of course there are some days where I have to work through lunch to stay on track if the morning was crazy.
After Lunch: More Documentation Time
Immediately at 1:00, all of us eating together disperse and run to find an open computer. From 1:00-2:00, I scramble to get the rest 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 everything 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 treatments.
If the afternoon is less than predictable, such as the patients 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 go back to my unit to the board.
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 try to look up the patients’ goals and needs beforehand, and bring the essentials that they may need, such as a hip kit or Theraband. I also try to keep these must-haves with me to stay prepared.
I try to do a lot of ADL retraining and 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 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 finishing treatments so I can have time to get my notes done without staying too 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 to 20 units but of course days can be higher or lower due to the 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 occupational therapist.
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, also be sure to check out my post on Acute Care Must-Haves to help get you through the day as smoothly as possible.