Acute Care is Intense

I started working in acute care as a student on my Level II fieldwork, so I never realized just how intensive it can be. I recently had a friend of mine who is an OT express interest in working in acute care. She wanted to follow me for a few hours to see how my day was.

Here is how I do a typical chart review before seeing a patient for the first time:

• Go on the computer
  • Check out the therapy orders, as well as their activity orders (out of bed, ambulate with assistive device, etc.) I also check what other services have been consulted. Is physical therapy on board? Social work? Rehabilitation? etc.
  • See what diagnostic tests have been ordered. A CT scan of the thorax may be ordered to rule out pulmonary emboli, ultrasound may be ordered to rule out DVT, x-ray to rule out fracture, etc.
  • Check on specific patient care orders – do they need a brace when out of bed? how many liters of oxygen should they be on?
  • Patient alerts – What kind of precautions are they on? Contact isolation? Are they on aspiration, neutropenic, or seizure precautions?
  • Diet – Are they NPO?  Stage I, II, III, or IV diet?  Knowing a patient’s diet can help with the education part of what they can and cannot do in the hospital
  • Code status – Are they DNR? Some patients have specific instructions as to whether or not they can be intubated
  • Lab values – The most common things I look for are hematocrit, hemoglobin, potassium, sodium, creatinine, PT/INR. Are the lab values high? low? Which way are they trending? All these are factors into whether or not a patient should be on hold. For example, if a patient has a hemoglobin of 7.5 and a hematocrit of 22.6, I would probably not see the patient, since they are below critical and are probably going to be too weak to see me anyway.
  • Vital signs – Check the latest blood pressure readings, heart rate, temperature, and sometimes the respiratory rate.
• Next, I check the physical chart:
  • I first go through the History of Present Illness section to see what led up to the hospitalization. Often times, I’ll find most of the patient’s past medical history.
  • Then, I check the consultation section to see what medical services have looked at the patient. This can include Medicine, Neurology, Orthopedics, Nephrology, Infectious Disease, Oncology, Cardiology, Pulmonary, and more. This section helps give a nice, complete picture of what is going on with the patient.
  • Next, I look throughout all the notes that everyone wrote. This includes mostly nursing notes, but also notes from doctors and from any of the above mentioned services giving updates. You see a progression of status as you read the notes.

I am only comfortable going into a patients room when I’m done looking up everything mentioned above. And now that I typed it all up, I can see why my friend who was shadowing for a few hours was so overwhelmed when she left! Working in acute care is intense; there is no question about it. But since I was brought in as a student and learned things slowly at a pace that a student would learn, I have no problem doing it today.

One of the great things with acute care (which others may specifically not like) is the fast pace. Going in to work, you never know who your new patients will be, making each and every day very unique. Often times, there are lots of new evaluations that need to be completed, so just the rush of trying to get everyone done makes the day go by very fast.

Acute care is definitely not for everyone, but if you can handle some of the minor stresses and be willing to learn a LOT about anything medical related, then it is for you!