Occupational Therapy in the Acute Care Setting
This post was originally published on July 4, 2016 and updated on April 16, 2019.
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 about to start fieldwork or a new job in acute care, this article will give you a better understanding of what OTs 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. 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 OT and PT) can figure out their discharge plan when they’re stable and ready to leave the hospital.
Patients’ conditions range from motor vehicle accidents, strokes, cardiac complications, falls, sudden illness, burns, and everything in between.
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.
Want to learn more about OT in acute care?Buy The E-book
What Do OTs Do in Acute Care?
Acute care OTs receive orders for patients and evaluate these individuals to first make sure they’re appropriate for OT services.
Some patients may be appropriate for OT, others may not. 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:
- Reduce risk of further decline
- Improve function
- Assist with discharge planning
Along with getting the patient up and moving, OTs also play an important role alongside physical therapy in discharge planning, assessing the patient each treatment of where they should go.
During treatments, the OT may provide education on energy conservation techniques, address self-care, functional mobility, or therapeutic exercise. OTs will 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):
- Therapy orders
- Lab values
- Vital signs
- Test results
- Weight bearing precautions
- Diet changes
- 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, here is very helpful and thorough lab values PDF resource to check out from Academy of Acute Care Physical Therapy. It’s 42 pages long but has everything you need to know to get started. 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!
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 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 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 8-30 minutes for the whole treatment, common acute care interventions include:
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.
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.
To avoid contractures, maintain joint integrity and prevent skin breakdown.
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 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 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, functional interventions.
This is because acute care OTs may have 5-10 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.
Is Acute Care Right For You?
Acute care can be challenging.
You have many more patients in a day, 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 OT 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 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 solid foundation of medical knowledge, which is very helpful to have in every other setting.
Where to Get More on Acute Care
If you’re about to start a position or fieldwork in 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 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.
And lastly if you’re looking for interventions and treatment ideas for your acute care patients, be sure to check out my e-book, Occupational Therapy Intervention in Acute Care.
Want to learn more about OT in acute care?Buy The E-book
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 let me know in the comments below!