Occupational Therapy in the Acute Care Setting

If you’re an occupational therapist working in the acute care setting, you know that it’s a whole different beast. It can be scary, fast-paced, exciting, and oh-so-educational.

Because of this, it can be pretty intense.

If you’re about to start fieldwork or a new job in acute care, this post will give you a better understanding of what OTs do in this setting. 

What is Acute Care?

First off, acute care is the inpatient hospital setting that an individual is admitted to when they have a sudden medical emergency. The main goal of acute care is to stabilize the patient.

Conditions range from motor vehicle accidents, strokes, falls, sudden illness, burns…you name it.

The main focus in the acute care setting is not rehab, but medically stabilizing the person. If ordered by the attending physician, it will be appropriate for you as an OT to evaluate and treat for the (usually) few short days the patient is in this setting.

The biggest goal for you as the OT is to help assist with where the patient goes next, whether it is home, subacute rehab, long term acute care, or inpatient rehab.

What Do OTs Do in Acute Care?

Acute care OTs receive orders for patients and evaluate these individuals to make sure they’re appropriate for OT services.

Some patients may be appropriate for OT, others many not. If the patient is medically stable, the OT will initiate treatment to get the patient up and moving.

The purpose of OT in the acute setting is to:
  1. Reduce risk of further decline
  2. Improve function

Along with getting the patient up and moving, OTs also play a large role in discharge planning, assessing the patient each treatment of where they should go. If time permits, the OT may work on self-care, functional mobility, and therapeutic exercise.

OTs will also recommend adaptive equipment and home modifications, if needed. This is especially true after an orthopedic surgery.

Since individuals in acute care on average have very short stays of two to three days, the OT may recommend further rehabilitation after discharge.

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.

OT Acute Care Medical Records

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

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

To make sure you’re up to speed on lab values, definitely don’t hesitate to do a full-blown Google search. Understanding lab values and vital signs is extremely important to check before working with each patient.

To get a basic idea before jumping in, you can check out the article Lab Values from the Physical Therapy Reviewer and Demystifying Lab Values from Advance Healthcare.

Your hospital will hopefully have easier to follow “cheat sheets” that you can bring with you to each patient.

Always Check With The Patient’s Nurse

After you check the patient’s information, you’ll also want to check in with the patient’s nurse beforehand to confirm they are okay to treat.

This is because orders can change, and vitals can change. Nurses in this setting are usually ahead of the game compared to the computer information if anything changes suddenly.

Speaking of nurses, make friends with them!

Patients in acute care, especially in intensive care, will have more lines and tubes than you know what to do with. You’ll be heavily 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 article (with pictures!) written by Christiane Perme, PT titled “ICU Equipment, Lines & Tubes: Lifeline or Tripline?” that covers what you’ll encounter in the ICU as well as precautions for the equipment.

What Interventions Can OTs Even Do in Acute Care?

Interventions will greatly vary from patient to patient. An OT might have a patient in a coma on a ventilator, or a patient that just had a hip replacement and is up and moving.

Keeping in mind that therapists may only have 8-25 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/weeks.

Bedside commode transfers and toilet transfers are also a favorite of mine, along with standing tolerance grooming or bathing at the sink.

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.

Splinting

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

Exercise Programs

My friends in this setting have come up with some really creative exercises like rolling up a towel and using it for upper extremity ROM exercises (towel dowel!) since there usually aren’t many other types of equipment handy.

Chair 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 bed rails to work up to gaining independence in dressing and toileting tasks. Grading the activity is important to ensure a “just-right challenge.”

Occupational Therapy Acute Care

Differences of Acute Care versus Traditional Rehab

Being an OT 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 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 interventions.

This is because acute care OTs may have 5-10 evaluations in one day. You’ll learn to prioritize what to work on. You also may do more education than treatment, 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.

Is Acute Care Right For You?

I won’t lie. Acute care is challenging.

You have many more patients, many more lines and IVs, less stable patients, and the added pressure of ensuring the optimal discharge location.

If you’re a new grad with no fieldwork experience in the setting, I personally would wait until you’ve had a year of rehab experience either in a SNF or acute rehab facility before you get into the acute care trenches.

It’s a personal preference, though. You may find an opportunity with a hospital with a strong mentorship program to guide you through the ropes for a few months.

I would not recommend going straight into acute care with no program in place to guide you, as there is so much to learn about safety and precautions.

If you’re a new graduate and really passionate about rehabbing patients, I would steer you more towards inpatient rehab, outpatient or a skilled nursing facility. OTs in acute care settings generally aren’t able to spend much time on rehabbing their patients.

Where to Get More on Acute Care

If you’re really passionate about being an acute care OT and need a great 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 started cross-training in acute care.

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.

Long story short, the book covers mostly everything you’ll likely encounter in acute care.

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I hope this post gives you an idea of occupational therapy in the acute setting. If I’m forgetting anything crucial, please let me know in the comments below. I’d love to keep adding to this post based on all of your various acute care experiences.

Also, I’d love to hear about any other great resources on this setting that you may have found.

Additional Resources

AOTA Factsheet: Occupational Therapy’s Role in Acute Care

Putting The Skill Back Into Acute Skilled Occupational Therapy (Providence Health and Services, 2014)

Rehabilitation for Stroke: Inpatient Acute Care (Uniform Data System for Medical Rehabilitation) Note: This is a bit longer of a Powerpoint and is geared towards stroke patients but has good information on importance of early intervention while in acute care as well as discharge information.

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8 comments

  • Kristen Lueck July 31, 2016   Reply →

    Great article on acute care. Your comment about making friends with your nursing staff is on point. This is also something I always include in my documentation. “Cleared by RN [ first name, last name ] for full OOB OT services as indicated by MD order. She/He RN reported pt status post [x] as [x].” Love the blog. Keep it up.

    • Sarah Stromsdorfer, OTR/L July 31, 2016   Reply →

      Thanks so much for your comment, Kristen! Your documentation example is great to ensure you’re covered if anything were to happen. I sometimes forget as an inpatient rehab OT the extra amount of precautionary measures acute care OTs need take on a regular basis, so that’s a super helpful phrase to use daily.

  • Allison November 30, 2016   Reply →

    I was wondering if anyone can give some advice on how to prepare for a setting changes or find mentors? There are no refresher courses in my state and I have basically been practicing OT in homecare now for 2 years without any guidance or mentorship and now need to be prepared to complete skills assessments for homecare interviews/prospective jobs. I did both my level II placements in school settings, and that was now almost 4 years ago anyways. I’ve never worked in a hospital, snf or any place outside homecare as an OT. I’m confident that I know a lot and have many skills, but don’t feel confident about interviewing or being assessed for phys days at this point without some guidance. Any feedback would really be appreciated.

    • Sarah Stromsdorfer, OTR/L November 30, 2016   Reply →

      Hi Allison,

      I understand the stress you must be going through. It sounds like you’re looking to advance your career within the home health setting but want advice on skill assessments for interviews. Medbridge is a really great resource with tons of training videos in its library that could help you get more familiar with skills assessments. They have videos that cover a variety of settings including home health. It’s about $200 a year with the coupon code found on OTPotential.com. While it may seem a little expensive, it’s totally worth it due to the unlimited courses it offers for the year.

      For something more 1-on-1 like a mentorship, you may want to consider working in a hospital or rehab setting where you have direct interaction with other experienced OTs on a daily basis. It’s a great way to gain the on-the-job knowledge and confidence you’re seeking.

      Lastly, I also offer 1-on-1 consulting re: these settings, interviewing, job changes, etc. No pressure, just want you to feel like you have options! Here’s the link: https://www.myotspot.com/product/consulting/

      I hope this can help you have a better sense of direction for achieving your career goals! Best of luck.

  • Denise G Doria April 1, 2017   Reply →

    Thanks for this post! I had a level II fieldwork in acute care and have currently been an OT in acute care for almost 2 months. It’s a whirlwind, constantly learning new things as each pt is completely different. Would love a post on more creative interventions within this setting– there are those rare times when I have a pt for almost a week (due to fluctuating lab values etc.) and want to keep therapy exciting and fresh. Thank you again, your site has been SO helpful!

  • Elisabeth Britz April 10, 2017   Reply →

    I found your blog really interesting. I have been a qualified OT for 27 years however aside from one year of working in acute medical when I was much younger, I have been working primarily in mental health and learning disability. I have now decided to return to the acute medical setting after 24 years and have just been offered a job in a local acute setting. Although I am very much looking forward to the challenge, I am filled with trepidation about the transition so any useful advice, experience or tips are gratefully received.

    • Sarah Stromsdorfer, OTR/L April 10, 2017   Reply →

      Hi Elisabeth, I definitely can relate about the challenges of switching to acute care. I’ll be writing more acute care-related posts for the site this year, but in the meantime also have a Facebook Group that you’re more than welcome to join if you have any questions related to the acute care setting. You can join here: https://www.facebook.com/groups/myotspot/

  • Elisabeth Britz April 11, 2017   Reply →

    Thanks Sarah that’s really great. When I get home this evening I shall look up your Facebook group.

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