Occupational Therapy in the Acute Care Setting

If you’re an occupational therapist working in the acute care setting, you already know that this setting is quite different from the traditional rehab-based settings. Acute care is fast-paced, intense, and so educational.

If you’re brand-new to acute care and you are about to start fieldwork or a new job in this setting, this article will give you a better understanding of what OT practitioners do in this setting and what you can expect.

What is Acute Care?

Acute care is the inpatient hospital setting that an individual is admitted to when they have a sudden medical emergency that requires intensive and immediate medical attention, or they have a planned procedure/surgery. 

The main goal for the patient in the acute care setting is to be stabilized and treated, then the medical team (with the help of occupational therapy and physical therapy, with speech therapy as needed) can figure out their discharge plan when they’re stable and ready to leave the hospital.

The types of people who are hospitalized in acute care can vary widely, but include:

Patients with acute medical conditions: These may include illnesses such as stroke, heart attacks,  respiratory failure, UTIs, diabetic ketoacidosis, and severe infections.

Patients with acute surgical conditions: These may include conditions such as appendicitis, pancreatitis, burns, bowel obstruction, and trauma-related injuries (which may or may not need surgery).

Patients with chronic medical conditions: Although acute care hospitals primarily provide short-term medical care, patients with chronic medical conditions may require hospitalization for acute exacerbations of their illness, such as worsening heart failure or chronic obstructive pulmonary disease (COPD).

Patients with mental health conditions: Acute care hospitals may also provide inpatient care for patients with acute mental health conditions, such as severe depression, psychosis, or suicidal ideation.

Patients with complex medical needs: Patients with complex medical needs, such as those requiring mechanical ventilation, emergency hemodialysis, or intravenous medications, may also require acute care hospitalization.

The main focus in the acute care setting is not solely rehab, but medically stabilizing the person first and foremost. If occupational therapy is ordered by the attending physician, the OT will evaluate the patient and if indicated, treat them for the (usually) few short days the patient is in this setting.

The biggest goal for the OT or COTA is to help assist the medical team with where the patient goes next, whether it is home, home with assist and home health, subacute rehab, long term acute care, inpatient rehab, or elsewhere, depending on their individual situation. This is along with treating them while they’re in acute care.

What Do Occupational Therapists Do in Acute Care?

Acute care occupational therapists receive orders for patients and evaluate these individuals to first make sure they’re appropriate for occupational therapy services.

Some patients may be appropriate for OT, others may not be. If the patient is medically stable and will benefit from skilled OT services, the OT will initiate treatment to create individualized goals with an additional focus to get the patient up and moving when possible.

The purpose of OT in the acute setting is to:

1. Evaluate the person’s current abilities (including self-care, cognition, and mobility)
2. Create a personalized treatment plan to address the patient’s function
3. Reduce risk of further decline
4. Improve functional independence through intervention
5. Assist the team with discharge planning

Along with getting the patient up and moving, OTs also play an important role alongside physical therapy in discharge planning and assessing the patient each treatment of where they should go after the hospital.

During treatments, the OT may provide education on energy conservation techniques, address self-care, cognition, vision, functional mobility, or therapeutic exercise. OTs can also recommend adaptive equipment and home modifications, if needed. These are just a few examples of the many treatments the acute care OT may provide in this setting.

Since individuals in acute care on average have very short stays of just a few days, the OT may recommend further rehabilitation after discharge if the person is below their prior level of function and would benefit from continued therapy. 

Acute Care Precautions For New OTs

Safety is of the utmost importance in acute care. Acute care patients are the least medically stable, and may have ever-changing orders and precautions.

Before you begin treating your patient, you’ll want to do a thorough chart review to check everything. This includes (but is not limited to):

1. Therapy orders
2. Lab values
3. Vital signs
4. Test results
5. Weight bearing precautions
6. Diet changes
7. Code status

If you aren’t sure about what a diagnosis is, or you need a refresher on lab values or a procedure, Google and your co-workers will be your best friends if you don’t have a cheat sheet from your facility.

Checking lab values and vital signs is an extremely important aspect in acute care since a change in status can happen quickly and can have significant implications. 

If you facility doesn’t have a condensed cheat sheet, you can check out this lab values reference guide from Physiopedia. Most hospitals do typically have easier to follow “cheat sheets” that you can bring with you to each patient and look at during chart reviews.

Before Treating, Always Check With The Patient’s Nurse

After you chart review your patient’s information and are ready to begin, you’ll also want to check in with the patient’s nurse beforehand to confirm they are okay to treat.

This is because things can happen quickly in acute care, and may not yet be in the computer. Orders can change, and patient’s status can quickly change. Nurses in this setting are typically ahead of the game compared to the computer information if anything changes suddenly.

Speaking of nurses, make friends with them, and the techs!

Patients in acute care, especially in intensive care, might have more lines and tubes than you know what to do with. In the ICU especially, you’ll be relying on the nurses to make sure you aren’t accidentally disconnecting anything during treatment.

If you aren’t familiar with all of the various lines and tubes, check out this easy-to-follow Powerpoint from Board Preppers (with images!): “Lines, Tubes, and Drains to Recognize, Evaluate and Treat.” This covers what you’ll encounter in the ICU and medical floors as well as the must-know precautions for the equipment.

What Interventions Can OTs Do in Acute Care?

Interventions will greatly vary from patient to patient. An OT might work with a low-functioning patient on a ventilator, or with a high-level patient that just had a hip replacement and is up and moving.

Keeping in mind that therapists may only have 10-30 minutes for the whole treatment, common acute care interventions include:

ADL Retraining

Grooming or dressing sitting edge of bed can mean a world of difference to a patient who hasn’t done oral hygiene in days and needs to build up strength and sitting balance.

Bedside commode transfers and toilet transfers are also a personal favorite, along with grooming or bathing at the sink to address standing tolerance and balance functionally.

My main goal with any ADL treatments is to incorporate mobility when possible, since oftentimes patients may only get edge of bed or out of bed with OT or PT.

Caregiver Education

This can run the gamut from safety post-discharge, information on the diagnosis, to additional rehabilitation recommendations. (For an in-depth review of caregiver education topics, check out 10 Family Education Topics for Occupational Therapists from the My OT Spot blog.)

DME Recommendations for Discharge to Home

This may include tub bench, bedside commode, or hip kit, for example.

Hand Splinting

To avoid contractures, maintain joint integrity and prevent skin breakdown.

Exercise Programs

In acute care, you will learn to get creative with upper body exercises by using what you have on hand. This can be rolling up a towel for a dowel or using water bottles for upper extremity ROM exercises since there usually aren’t many other types of equipment handy.

Chair or wall push-ups and sit to stands from the toilet are also great if the patient can tolerate it.

You definitely learn to get pretty creative with these interventions when you have limited supplies.

Addressing the Patient’s Deficits

This is done through function like bed mobility, bedside commode transfers, or even standing with support of a walker to work up to gaining independence in dressing and toileting tasks. Grading the activity is important to ensure a “just-right challenge.”

Differences of Acute Care versus Traditional Rehab

Being an occupational therapist working in acute care is vastly different than other settings. You don’t have much time to work with the patient – typically only a few days.

In acute rehab, you really get to know your patients and work with them over extended periods of time. In acute care, it’s rare that you’ll get more than a few days with the person.

Instead of doing a full hour-long ADL retraining session like you’d do in rehab, you’ll be more focused on quick, functional interventions.

This is because acute care OTs may have 5+ evaluations plus additional treatments all in one day. You’ll learn to prioritize what to work on. Along with quick treatments, you also may have to quickly squeeze in education, especially on discharge planning with the patient and their caregivers.

Even though you only have a brief time with the patient, you can still be assured you’re making an impact in their long-term recovery by ensuring they get the best outcomes post-discharge from the acute care setting.

For more about the differences between acute care and inpatient rehab, be sure to check out our article, “Occupational Therapy’s Role in Inpatient Settings.”

Is Acute Care Right For You?

Acute care can be challenging.

You will see many patients in a day, will work with more lines and IVs, less stable patients, and the added pressure of ensuring the optimal discharge location. Increased stress also comes in if your patient is unable to discharge to their safest/most optimal location, depending on insurance, doctors, family, etc. 

If you’re a new occupational therapy grad with no fieldwork experience in the setting, and want to start in acute care, make sure the hospital will be providing you with a solid mentorship once you start. 

I would not recommend going straight into acute care with no mentor to guide you, as there is so much to learn about safety and precautions, not to mention treatments, the ins and outs of discharge planning, etc.

If you’re a new graduate and really passionate about rehabbing patients for more than just a few days, I would steer you more towards inpatient rehab, outpatient therapy or a skilled nursing facility. OTs in acute care aren’t able to spend much time on rehabbing their patients and may just see them a handful of times.

You will, however, gain a great foundation of medical knowledge, which is very helpful to have in every other setting.

Where to Get More Info About Acute Care

If you’re about to start a position or fieldwork in acute care OT and need a thorough resource, I highly recommend the textbook Occupational Therapy in Acute Care. It’s a textbook that you may already have from school.

It was written collaboratively by acute care OTs for acute care OTs, and was a godsend for me when I switched to acute care from inpatient rehab.

The book covers everything relating to acute care:

Common conditions, diseases, procedures, to evaluations, the ICU, all bodily systems, infectious diseases, autoimmune disorders, dysphagia, transplantation, and burns.

In addition, the book includes:

Lab values, common diagnostic tests, medications, altered mental status, low vision, bariatrics, vertigo, safe patient handling, pain management, evidence-based practice, ethics, discharge planning, and blood disorders.

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And lastly, if you’re looking for a quick resource covering interventions and treatment ideas for your acute care patients, be sure to also check out our e-book, Occupational Therapy Intervention in Acute Care.

 

I hope this post gives you a good idea of what occupational therapy in the acute care setting consists of.

If you work in acute care, what else would you add to this post? Please share in the comments below!

Additional Acute Care Resources

Occupational Therapy in the ICU: An Interview with an ICU OT (My OT Spot)

A Day in the Life of an Acute Care OT (My OT Spot)

AOTA Factsheet: Occupational Therapy’s Role in Acute Care

This post was originally published on July 4, 2016 and updated on February 25, 2021 and May 4, 2023.