A Day in the Life of an Outpatient Hand Therapist
We’re really excited to continue our Day in the Life series featuring certified hand therapist Emi Ito, OTR/L, CHT. In this article, Emi shares what a day in the life is like working as an outpatient hand therapist as well as helpful information for anyone interested in working in hand therapy.
Hand Therapy Settings
Hand therapy can be practiced in a variety of settings. A 2017 survey by the Hand Therapy Certification Commission found that 47% of certified hand therapists worked in hospital-based practices (inpatient or outpatient), 16% worked in corporate-owned outpatient practices, 11% in physician-owned practices, and another 11% in therapist-owned practices. The remaining were in educational institutions, skilled nursing facilities, home health, or were self-employed/independent contractors.
You might have noticed that a large majority of the therapists practice in the outpatient setting – this is because hand problems generally do not require acute medical attention.
Where I Work
I started out as an inpatient therapist in acute care, which helped me develop my skills as an occupational therapist. I learned to look at the whole individual and factors affecting the individual rather than having tunnel vision reducing a patient to their arm.
Currently I work in a hospital-based outpatient clinic. I also float to inpatient if I have a cancellation or if there is a patient in the hospital who just underwent orthopedic upper extremity surgery. It is rare for a patient with only an upper extremity orthopedic injury to be admitted to the hospital, but there are cases where the patient has other (sometimes related) medical conditions that lead to hospitalization (e.g. anemia leading to fall, causing a humeral fracture).
Knowing Your Schedule
The thing I like about being an outpatient therapist is knowing my schedule ahead of time, including who the patients are that I will be treating the next day, even for the whole week. As patients need to schedule appointments, there is less of a surprise factor compared to acute care where patients are assigned to therapists in the morning.
Of course, there may be days where the schedule just falls apart (e.g. cancellations, no shows, last minute request to squeeze in a patient, or a treatment taking longer than anticipated). I can generally look at my schedule in the morning and anticipate how the day will turn out.
My Morning Starts The Evening Before!
Since I can see my schedule for the next day, I tend to review my patient list the day before at the end of my day. I can check to see if any of the patients are due for a progress note (usually every month) and plan my schedule accordingly. If I see that I have a new patient evaluation scheduled, I can review the patient’s chart to prepare for the evaluation. This is especially important since I need to make sure there is an occupational therapy prescription and, if needed, insurance authorization for the evaluation. Otherwise I can’t perform the evaluation!
I also check to see if the patient is post-op, and if so, whether the operative note is available. Post-op patients may take more time depending on the surgery. For example, if a patient had a flexor tendon repair, I will likely need to make a custom fabricated dorsal blocking orthosis to protect the repair. This would take more time than an evaluation of a patient coming in with Carpal Tunnel Syndrome. Knowing what took place during surgery can also be very important.
Going back to the flexor tendon repair example, knowing what suture technique the surgeon utilized can influence how strong the repair is, which could then influence what exercises are taught to the patient at evaluation. If prescription information, insurance information, and operative notes are not available, I let our admin staff know ahead of time so they can work on obtaining it.
My Actual Morning
My first patient appointment is at 8:00 AM. This means I have to be READY to see my patient at 8:00 AM. Since I have prepped the day before, I get to work about 10 minutes before my start time. I clock in on our time-keeping machine, and log on to the computer in the charting room to see if my patient has been checked-in by the front desk staff.
We use EPIC for our scheduling and documentation, which keeps everything easily accessible on one platform. I have also worked in other clinics where EPIC was used for scheduling, and a different system was used for the actual therapy documentation. As with the rest of healthcare, most outpatient therapy facilities now use EMR and paper charts are a thing of the past.
At my current facility, evaluations are one hour, and treatments are forty-five minutes. Patients are treated one-on-one by the therapist for the whole duration of the session. (Note: This is NOT the norm for most hand therapy settings. I have worked at another hospital-based outpatient clinic where hour-long evaluations were performed one-on-one but hour-long treatments were double-booked with another patient. At one of my fieldwork sites, patients were scheduled every 15 minutes, so at any given time there were 3-4 patients sitting around a semi-circular table being treated by one hand therapist!)
I see patients up until noon, with one fifteen minute break in between. Often times the break is used to catch up on a little on the documentation. I try to document as much as possible during the session. Things I tend to document immediately are patients’ subjective reports such as their response to the previous treatment, if things are improving, or if there’s been any changes or updates.
I also try to document their pain report at point of service as most likely I will not accurately recall this at a later time (this is required for most documentation). In my experience, this is something that tends to be more difficult in the inpatient setting because either the computer is not close by, or the patient is not safe enough (decreased balance, medically fragile) for the therapist to move to a computer to chart if the patient is sitting at the edge of the bed.
Lunch for me is half an hour: 12:00 – 12:30 pm. We are on a time clock, so every minute counts! I generally bring a lunch so I have as much time to eat my lunch, rather than running to buy food and having only 15-20 minutes to eat. Lunch is a fun time to interact with other coworkers, or to just relax before the work picks up again.
After lunch, I usually have 15 minutes to finish up as much of the morning documentation as possible. On certain days, I may also have meetings scheduled right after lunch like a staff meeting, interdisciplinary case reviews, or lymphedema team meeting. (I generally treat hand therapy patients, but once in a while I also treat patients with lymphedema).
The Afternoon Grind
The afternoon appointments start up at 12:45 pm. As in the morning, appointments are generally forty-five minutes unless I’m evaluating a new patient. If I have a cancellation, I may float over to help see an inpatient. Otherwise I try to catch up on other paperwork, such as making sure my plan of care for patients have been signed by the referring doctors, checking on insurance authorizations, or ordering clinic supplies.
My last appointment is usually at 3:00 pm or 3:15 pm, and I try to finish up treatments usually around 4:00 pm. I make sure the clinic is organized and equipment sanitized. After that, it’s a rush to finish all the documentation!
End of Day
At the end of the day, everybody is back in the charting room. Depending on how busy we were, the charting room may be silent with only the sounds of frantic typing and clicking away on the mouse (EPIC involves a lot of mouse clicking) or there may be some light chatter.
The amount of documentation really depends on the type of treatment sessions that occurred during the day: evaluations, progress notes, and discharge notes take longer compared to a regular treatment note. An evaluation may take me anywhere from 15-30 minutes to type up, and sometimes I need to fill out extra paperwork for the insurance. Progress notes and discharge notes may take up to 20 minutes. A treatment note generally takes about 5-10 minutes.
When I’m done with all my documentation, I run the revenue and billing program that is in EPIC to check to make sure I’ve billed all the units correctly and to check that I made the expected unit of productivity. If everything checks out, I review the next day’s schedule. By 4:30 pm I am clocking out, and it’s a wrap!
We want to give another huge thanks to Emi for sharing her day in the life as a hand therapist! For more of our Occupational Therapy Day in the Life series, be sure to check out other other articles listed below: