Acute Care is Intense

February 11, 2008 at 4:29 pm 53 comments

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!


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Continuing Education links Educating Patients with Amputations

53 Comments Add your own

  • 1. Bridgette  |  February 13, 2008 at 12:28 am

    Nice recap! I just finished my Level IIs at an acute care hospital and did exactly that same routine before ever seeing a patient. Now I’m studying for NBCOT and that, as well as much other info in your blog, was a very helpful review. Thanks a lot and keep it up!

  • 2. aishel  |  February 13, 2008 at 12:43 am

    Thanks Bridgette! Good luck on your exams! I’m sure you’ll do great. Make sure to check out the brief guide I wrote on studying for the exam:

  • 3. Suhaila Usuludin  |  March 18, 2008 at 10:38 am

    Hi! I totally agree with you. I have just graduated and currently working in an acute hospital. Besides going through the transition of being a student to a therapist, I have to face many challenges in an acute setting such as the various medical terms and diagnoses etc.

    As challenges being challenges, I am taking them in my stride as I hope to learn as much as so as to make this a positive working experience.

    Anyway, good guideline there! 🙂

  • 4. Itzmiuga  |  April 2, 2008 at 3:37 am

    Just a query, how long do you take to read through all these?
    Because, in my country, we are only given about 15 – 30 minutes to assess a patient, which includes reading the case files.
    I do know the importance of finding out as much info about the patient as possible.

  • 5. aishel  |  April 2, 2008 at 6:04 am

    Itzmiuga, it really varies. Working on an orthopedic or trauma floor, the patients can often be young or have limited past medical histories, which make it quick. Working on an oncology floor may mean it take a bit more time. There have been times where it has taken me a full half hour just to do a chart review! Luckily, my hospital is very kind when it comes to productivity, as they understand that acute care requires more time with chart reviews.

  • 6. Jools  |  June 10, 2008 at 10:10 am

    Wow that brings back memories of my level 3 placement which i finished 3 weeks ago. I am now trying to write a reflective piece on the placement but there is so much i want to include. I found the acure medical ward difficult to get to grips with at first as it was so different to my previous placements. By the end of it, (12 weeks) i finally got used to it. Not sure if it is an area i want to go into though. I was great to read your blog.

  • 7. Doni  |  June 15, 2008 at 1:53 pm

    This was so helpful for me. I will start my level II in acute care in two weeks, particulary with Ortho and I am a bit nervous about what to expect.
    I was informed by my supervisor that acute care is very intense, spontaneous and fast-pace. I was also told that my caseload would be intense as well.
    I WOULD LIKE TO KNOW….HOW DID YOU (or any of you that worked in acute care) manage your caseload??? I was told that this is extremely important and that I would have to find ways to do this.

  • 8. aishel  |  June 15, 2008 at 3:55 pm

    Doni, don’t worry, you won’t be getting a full caseload on your very first day. It’ll take weeks until you get even a 50% caseload. The point of the fieldwork is that by week 12, you’ll be a competent entry-level OT. So by week 10-12, you should have a full caseload.

  • 9. Doni  |  June 20, 2008 at 5:18 pm

    Aishel..thank you so much. I took a visit to my school today to disucss fieldwork with my field coordinator, and she said the same exact thing you said. Again…thanks.

  • 10. Anik  |  February 16, 2009 at 10:40 pm

    Do you have a reference book/article/web site you recommend particularly for lab values? You were mentioning situations where you would not see the patient if he has hemoglobin of 7.5 and a hematocrit of 22.6… It’s easy to find the norm or range but the impact on function is less obvious and most important to us as OTs(i.e. when to do AROM vs PROM, when to get the patient up to a chair, etc.) or do you just go by the fact that they are “below critical” and not see them? Thanks

  • 11. Linda  |  April 5, 2009 at 9:01 am

    I am thinking of switching from pediatrics to acute care. I have been working in public and private schools the past 10 years and though I have extensive rehab experience it was over 20 years ago. I’m wondering if I can do this. What would you suggest to get my skills back up to speed? Linda

  • 12. Belinda  |  April 20, 2009 at 12:13 pm

    I have had a few OT’s switch. It is hard to say what is best other than shadow some. I have one therapist working weekends as prn to trial the acute care arena before switching.
    I would like to hear form acute therapists what is the latest and greatest in the world of acute care? Hectic pace, people more ill….what are OT’s doing in acute? Belinda

  • 13. Jennifer  |  May 3, 2009 at 7:12 am

    I just started doing PRN work in acute care after 9 years in pediatrics (school system). I am trying to find sample LTGs and STGs for acute care setting. I am trying to get a clear understanding of what to expect in such a short time frame. This is so very different than writing goals for a whole school year. What are realistic expectations for acute care goals?

    • 14. Jes  |  April 12, 2011 at 11:18 am

      It looks like this comment was posted almost 2 years ago, but to answer your question, a set of STG’s might look like this (for, say a spinal surgery patient):

      1. Pt will dress lower body with Modified Independence (adapted equipment as needed).
      2. Pt will demonstrate toilet transfer with stand-by assistance or better, using appropriate durable medical equipment. (such as raised toilet seat or commode, grab bars, walker)
      3. Pt will demonstrate modified independence in tub transfer technique using walker, grab bars, and shower chair as needed.
      4. Pt will tolerate 10 minutes or more of grooming and hygiene activities while standing at the sink and using walker or adapted equipment as needed.
      5. Pt will verbalize spinal precautions (no bending, lifting >10lbs, or twisting).
      6.Pt will demonstrate compliance with all spinal precautions during performance of ADLs, with minimal verbal cueing.

      Of course these are tailored to where the patient is at. They may already be completing toileting on their own when you first see them, or they may have a walk-in shower or choose not to focus on that area. Often they can “do” each of the things listed above, but they need to be observed doing them while maintaining spinal precautions.

      In general, a LTG would be that patient will return to previous living situation and level of independence.

  • 15. karen wells  |  May 3, 2010 at 9:46 pm

    OK. I do all the review prior to seeing the live person. My question and challenge – how do I draft a good/accurate/fast hand written daily note? Any suggestions would really be appreciated.

    • 16. Jes  |  April 12, 2011 at 11:33 am

      A general daily note in my setting might read:
      Eval completed and tx initiated. Pt c/o pain 6/10 but was agreeable to therapy. Pt went supine>sit with min A and sitstand with bed elevated , WW and SBA for balance. Pt edu on AE for dressing LE and was provided with written HO on available DME. Pt donned pants and socks while sitting on EOB using dressing stick and sock aid. Pt needed 2 attempts to succesfully don socks and will benefit from review of technique. Pt SBA for transfer on/off toilet using grab bars and WW. Pt demo’d compliance with precautions throughout session and c/o increased fatigue after donning pants. Recommend DC to home with assist when OT goals are met and pt is medically stable. Plan to continue with daily OT session to reinforce modified dressing technique and post-surgical precs, and increase tolerance for ADL completion.

      • 17. Jes  |  April 12, 2011 at 11:35 am

        these are some of the terms that I remember not knowing at first, but picked them up after the first few days of reading other therapists’ notes:

        WW: wheeled walker
        SBA: stand-by assist
        AE: adaptive equipment
        LE: lower extremities
        HO: handout
        DME: durable medical equipment
        DC: discharge

  • 18. Tee  |  May 16, 2010 at 9:43 pm

    HI, I am currently on my level II fieldwork in acute care. I found these comments helpful, but the hardest part for me is determining the right interventions to use with each client. I was wondering if anyone has good resources that included good examples of intervetions to do in acute care? Anything would be helpful.
    Thanks Tee

    • 19. Jes  |  April 12, 2011 at 11:43 am

      training in compensatory techniques
      education in adaptive equipment or durable medical equipment
      edu on ADL completion with (…) precautions
      training in one-handed dressing techniques
      training in energy conservation or fatigue management
      functional endurance training
      therapeutic exercise/training in home exercise program
      grading ADLs to facilitate independence
      cognitive assessment or interventions
      education in prosthesis wearing, donning/doffing technique
      neuromuscular re-education
      functional transfer training (body mechanics when getting in/out of bed, on/off toilet, in/out of bathtub)
      education on fall risk and prevention
      manual therapy
      caregiver education

      …the list goes on and on. 🙂

      • 20. kenneth /ota  |  September 1, 2015 at 11:58 am

        Thank you so much! If at all possible keep the list going lol

  • 21. mal  |  September 26, 2010 at 2:51 pm

    Hi just wondering what type of interview questions do they ask for an acute OT job?

    • 22. Jes  |  April 12, 2011 at 11:49 am

      They will likely want to know your experience with assessments like the FIM, the CPT, manual muscle testing, fine motor testing, etc. During my very first interview, I blanked on the names of assessments, so at least make a list before your interview.

      My hospital is currently revamping their interview process to target “character traits” instead of purely clinical skills. Questions they ask include: Describe a time in which you provided excellent customer service. Describe a time when a patient/customer was unhappy with the services they received and what did you do?

      In an acute care setting, you must have a lot of autonomy, so they will likely ask what supervisory style works best for you, or how often you prefer to have someone checking in on you.

      I’ve also just been asked “what are the strengths you bring to this job?,” “what do you do when you have a patient with a diagnosis you’ve never heard of?,” and “how do you respond to a constantly changing schedule?”

  • 23. concerned  |  December 6, 2010 at 1:57 pm

    OT services in an Acute care hospital are a complete waste of money and resources. The average length of stay in an Acute care hospitals is 3 days or less. An OT evaluation is a waste of time on a patient who is already seen by PT and when the patient is going to DC to HH, SNF, Rehab or OP where OT services are really called for and of benefit to the patient.

    • 24. MPH1966  |  March 7, 2011 at 9:55 pm

      Wow, it concerns me that you have this viewpoint. Have you worked in an acute care hospital? I have worked in one for years and see many benefits to being in the acute care setting. I have over 21 years of experience and have worked in almost every setting. I find great satisfaction in the acute care setting. I am able to provide pts w/ education to increase their safety and indep. When I am able to provide follow-up visits, I have been able to help them return home rather than a NH/SNF setting. OT’s also look at the pt in a more wholistic approach. I have had PT’s say a pt in safe to go home and not even consider how this pt who lives alone is going to manage 3 meals a day, take care of basic ADLs, etc.

    • 25. Jes  |  April 12, 2011 at 11:57 am

      Keep in mind that without the ADL assessments, cognitive assessments, and training that comes from an OT, many physicians would not know where to send their pt’s after DC. Acute care rehab plays a big role in determining the best setting and whether or not they will need further services which is a huge cost saving benefit. Sometimes pt’s are set to go to extended rehab but they quickly meet their OT and PT goals and it is clear that they don’t need that intensity of care. By the same token, pt’s that might have been sent home (only to fall and incur greater medical costs, extended recovery, etc), are identified by OT as being at risk and are set up with home safety evals or short term rehab.

    • 26. MARY M  |  February 2, 2012 at 11:54 am

      couldn’t agree more. Not to mention loaded with fraud!!!!! Why would a patient who comes in with just the flu- need OT ??? they didnt forget how to dress- they are just too sick!!! and who puts on close in the hospital, no one showers and I have yet to see any OT make a splint or a piece of adaptive equipment!!!!
      You are wasting taxpayer Medicare monies and stealing from private insurers!!!! As a nurse cae manager I have seem it all. And you are teaching young therapists to commit fraud and misrepresent whta they are going!!!

      I watched an OT walk my mother donw the hall when she could al- ready walk and bill for it!! I have seen OTs and PTs spend less than 5 minutes in a room and bill for 30.
      Your professions are a disgrace for healthcare providers!!

      Nurses have been doing many of the things you bill for for years!!!




      • 27. Samantha  |  February 29, 2012 at 6:21 pm

        Yikes! You sound disgruntled and like someone who has absolutely no idea what OT’s and PT’s are assessing and treating. We aren’t looking through the same lenses you are. You sound a little burnt out. Read up on the benefits of implementing OCCUPATIONAL BALANCE in your life and treat yourself to a vacation and some R&R. =)

  • 28. Courtney  |  April 18, 2011 at 6:28 pm

    This is great! I am in my 3rd week of Level II Fieldwork in an acute care setting. Although it’s super busy and a crazy learning environment, I am really enjoying it!

  • 29. unhappy in acute  |  May 15, 2011 at 5:06 pm

    i’m currently doing my level II placement in an acute setting and have foundit incredibly difficult to get to grips with coming from mental health and rehab placements. For me, working in an acute setting does not seem patient-centred at all. There is very little therapy time and a lot of pressure from the Drs and Nursing staff to get patients ‘out of the door’ asap, with no consideration about whether the patient is safe to go home. I will not be seeking a placement in an acute setting when I graduate, this is not what I went into to OT for!

  • 30. Nika  |  May 31, 2011 at 6:51 pm

    I appreciate all the info on Acute Care OT. I begin my first Level II in about 4 weeks. I’ll take all the advice and suggestions I can get. 🙂

  • 31. New Grad  |  June 28, 2011 at 7:37 pm

    Hello everyone,

    I am a new grad working in an acute care setting. It was my decision to choose acute care as my first job. I have always had the passion to work in this setting. Acute care always intrigued me as its fast paced and rehab portion is considered crucial. With hospitals now a days trying to d/c pt. ASAP, OT’s role becomes vital is d/c planning process.

    As months go by, I am questioning my decision (not regretting, just questioning) of working in this setting. As someone pointed out earlier, if PT gets their eval done first, OT evals are not always necessary. It is a waste of time. If the pt. is going to comp rehab, they need two disciplines (PT and OT) evals. However, if its a joint pt., whatever PT says goes. There were so many patients that i personally felt could benefit from home OT for home safety assessment and education on home management post d/c but they did not get home OT because home PT is more important. Also, OTs cannot open home health cases.

    It is rare that I hear case managers/social workers asking for OT evals. It’s more like “PT hasn’t seen the pt, we need PT eval”
    Doc. write PT/OT as if its one discipline. I understand as OTs we need to do more education on our roles.

    Recently, I was evaluating a Pt. who was about to be d/c home. It was a cancer pt. with low endurance.PT and I decided to complete eval together. PT told me the pt is high functioning and may not need home therapy. She was right.
    Once I evaled the pt. i felt that pt can def. benefit from Home OT for home safety assessment so i mentioned to the pt and family if there are any home safety concerns? Family reported they dont have any but not sure. I told them maybe we can order home OT. I explained to them that home OT can teach the pt. energy conservation techniques while completing ADL. PT quickly interrupted saying “I can recommend home PT, PTs can do all the home assessment and teach pt. energy conservation techniques”. I was bit surprised and confused. Im not sure what she was trying to imply. I def. wasn’t happy with her.
    I simply gave pt the handout and wished her goodluck.

    There are def. high and low moments in acute care. Some of the low moments are when pt./family members constantly hearing “physical therapy” after i tell them I am Occupational therapist for the 10th time. Drives me crazy because I am a new grad.

    Am i the only one going through this?? How are you guys resolving these types of conflicts?

    • 32. nicola  |  July 8, 2011 at 11:56 am

      hi new grad,
      you are definitely not the only one that is undermined by PT’s. I have worked in a community setting for 16 months now & the PTs opinion will always get listened to over mine, if I want to order a special piece of equipment I have to have the PTs agreement that physio can not help, of course the PT assessment process delays the ordering and often patients are left waiting longer than necessary. I have an interview for acute rotation on monday as I am sick of the lack of respect shown to OT’s in the community. We need to become more assertive as a profession, but I have no idea how to do this without upsetting the rest of the team!

    • 33. christy  |  September 29, 2012 at 9:37 pm

      I have worked as an acute OT for over a decade. The best way to advocate for OT, or for patients, is to know your own role very well. Even now, I ask myself with each patient “What is my skilled role and how can my role benefit this patient.” A big responsibility for every OT is to stay current and communiate with other OTs. This has happened informally for me with good OT friends over the years. Long after graduating from OT school, we continue to learn from one another; new tx strategies, adaptation, modification techs, etc. Education of how we may uniquely contribute to the acute team is also a big resposibility….and it is ongoing. Do not assume that PT always knows the full scope of OT. Take experiences that may feel undermining as teaching opportunities for PT. Likewise, demonstrate openess to learning more about PT, SLP, PA, SW, etc. Creating the culture of collaboration makes us more approachable with questions about or role and our importance on the acute team. Suggestion: Offer inservices that help to clarify role to teams. Case studies wear PT and OT talk about what they would do in different case examples, opens communication for everyone. Good luck!

      • 34. christy  |  September 29, 2012 at 9:39 pm

        Oh, and that’s case studies ‘where’….. appropriate typo for an OT however 🙂

  • 35. Rachel  |  August 3, 2011 at 5:34 pm

    I am just starting my Level II’s, I am at an Acute facility, and I absolutely love it. I have so much more to learn and reading this has helped settle my nerves so much………thank you everyone

  • 36. Stephanie  |  August 6, 2011 at 2:02 am

    Hi! Your post has been helpful. I am also doing my Level II placement in an acute care unit and am still having a difficult time understanding all the diagnoses/procedures and medical terms. I was curious to know what types of ADL assessments you found helpful in this setting?

    Also, I just read in the latest OT Practice that a new book “Occupational Therapy in Acute Care” was published this year. Hopefully it will help some of you!

  • 37. Julie  |  February 21, 2012 at 9:20 pm

    OT in acute care is absolutely a necessity. Physical Therapist do not receive adequate training in Cognition and mental Health issues. PT’s are experts at assessing physical impairments impeding a patients ability to mobilize independently. I have been an Acute Care Therapist for 17 years and have wisely picked my battles with peers, supervisors and Doctors. Always with respect. I once stopped an Orthopedic Doctor and asked him why he did not believe in OT. To his credit he listened to my concerns and expressed he did not understand why a patient would need OT, they just have an ankle fracture. They need to get up and move, he said. Well what do you think people do when they get up to gather their clothes, stand at the sink to brush their teeth navigate the shower with only one Weight bearing LE? The Orthopedic Surgeon suddenly recognized PT does not cover all the ADL issues patient’s encounter while recovering from an injury. Just from that one conversation he began ordering PT and OT with all of his LE surgical patients. Quite often I am able to uncover undiagnosed Strokes, Cognitive deficits and pre-morbid deficits through a thorough ADL history intake. To all OT’s treating in Acute Care it is imperative to stick to your guns, provide effective education to hospital personnel and ensure you are always incorporating an ADL focus with your session. It is okay to walk your patient’s down the hall if your purpose is related to an ADL activity, for example in a Neurological patient the OT may be assessing the persons ability to find there way, can they read the signs, ask for help to find their way back to their room. Without OT the patients often do not even realize what ADL difficulties they will have upon their d/c home. Why does a person with the flu or pneumonia need an OT? Never make assumptions based on the diagnosis, how old is this patient, perhaps pt. has been declining with physical and mental capacity, perhaps pt. has an undiagnosed stroke and developed pneumonia because of dysphagia etc, etc. I could go on and on forever. Sometimes pt’s just need PT, sometimes patients just need OT, by and large most patients needing a PT benefit from both of us. The ability to mobilize is a one primary part of our humanity, Managing ADL’s, IADL’s , Higher level processing these skills are what enables people to be fully functioning independent individuals in society. These advanced skills are best assessed by the appropriate experts OT and Speech, Not Physical Therapists.

    • 38.  |  December 19, 2012 at 8:21 pm

      I like your attitude. I work in acute as well. We’re understaffed pretty badly. How about you?

      • 39. Julie  |  December 19, 2012 at 9:11 pm

        Thanks, I work in a system having a number of hospitals and most of them barely use OT with the exception of the trauma center and the rehab branch. Currently a new boss with an extremely narrow view of OT purpose is concerning our entire OT department. We suspect we will be losing more peers in the near future. Our census has been up and down so we are either overstaffed or understaffed rarely a happy medium. Looking to move into more community oriented OT, believe there will be a big future in this with the baby boomers retiring.

  • 40. Eric  |  March 9, 2012 at 10:53 pm

    I am currently entering an acute care setting for FW II. I am nervous and excillerated simultaneously, as this is what brought me into the profession. Any advice, be it words or literature, for me to go in super prepared?


    • 41. janice  |  May 2, 2012 at 7:24 pm

      I have a job interview tmrw for an acute setting..can anyone pls share with me critical questions to ask about the job? p.s i’ve only had SNF experience.. thanks and this is a great website;)

  • 42. Shannon  |  May 17, 2012 at 6:02 am

    Hi, I am a second year Occupational Therapy student at Wintec in Hamilton, NZ. Have completed my first Viva on a acute medical ward today and just finishing an assignment on blogging. Was great to find this and read about the acute medical ward 🙂

  • 43. winner indeed  |  May 18, 2012 at 2:44 am

    This is fantastic as I failed an interview to work in a medical ward of a big central London hospital yesterday, being 17/05/2012. I felt a rush of destpair but when I read through all these blogs, I felt the interviewers’ decision not to take/pass me was justified indeed!
    I am reading me and preparing for my next interview which is a milestone one, hopefully!

  • 44. Bella  |  August 21, 2012 at 5:12 pm

    I recently took a job in acute care as a new graduate. Acute care is where my heart is. The only thing I am finding is that at this hospital there is no co-treatment with PT and the aides basically work with the PTs as well. Because of this I find a lot of times I am unable to do a lot of things with patients, such as, transfers, bed mobility, and dressing. I am trying to find ways to include and evaluate ADL status. Can anyone share their knowledge, interesting tactics to evaluating and treating patients in acute care at bedside. (I forgot to mention that all treatments are done bedside, they are never brought to the gym). Any ideas would be greatly appreciated.

    • 45. Julie  |  August 30, 2012 at 8:58 pm

      as an 18 year veteran of Acute Care I recommend you both stop limiting yourselves. Utilize the environment you are in. For Patients at Mod A level or higher walk them to the bathroom for standing ADL activity. Teach them how to gather items out of the closet. I often will walk them to the floor kitchenette and show them how to navigate obstacles with their walkers to get items from the fridge, cabinets, make their own coffee. Low Level patients POC will depend on what the diagnosis is. General? CVA? Ortho? Having pt’s practice dressing at the edge of the bed is good. Don’t forget to fully assess vision and cognition there are plenty of activities you can do to help progress patients with these deficits. FMC can improve more rapidly when incorporating exercises for eye hand coordination, hitting a balloon. Balling up paper towels and aiming for the garbage can. There are so many things readily available to you on the floors and in the rooms. If I have a Pt. needing to use the toilet and they are Max A I partner with the PCA on the floor. OT’s do not need PT’s to mobilize low level patients……Be creative……Good Luck and always keep your abdominal muscles engaged when performing any physical transfers and activity with your patients–this will help protect your back.

      • 46. newtoacute  |  September 19, 2012 at 11:10 pm

        Thanks for your response!

  • 47. newtoacute  |  August 29, 2012 at 7:48 pm

    Wow, Bella, I am in the exact same situation as you. Unless I feel that I can safely sit a patient up at bedside and/or complete functional mobility in their hospital room without help from anyone else, I feel that I am very limited in what I can do with weaker/lower level patients. I would love to hear ideas from other therapists as well!

  • 48. Mary  |  January 14, 2013 at 8:20 pm

    Is anyone having the experience of hospitals eliminating OT services in acute care? Many hospitals in my area seem to be doing this. Any suggestions that have been successful to justify services. We continue to provide OT but have limited staff. We often will screen and defer some patients out of priority. I am wondering if this is a problem, as there was a phsyican order,are we out of compliance?

  • 49. Quinn  |  April 6, 2013 at 10:49 pm

    Hi everyone! I just accepted a full-time position to work in acute care, and I have to say that I loved reading the blog post and all of the responses. My license just came through and I will start Monday, and I am incredibly excited. I have some experience from my level II, but it’s always different when you are the solo therapist making all the decisions.

    Anyway, I wanted to thank you for writing this, as I was/am feeling nervous about working in acute care, but after reading how you go through a chart review, I don’t feel as nervous, because that is how I prep for patients as well. It is important to know the patient as best you can before going in, and even if you’re limited in time, you can still get a good picture.

    I’ve also found that conferring with the nurse on a new eval is best. They know the patient better than you and can give a good picture of how they’re doing that day.

    I have found the relationship between therapists to be different at my hospital. The PT and OTs are really a team, and while it is true that if PT sees an eval OT does not really “need” to see them, it is not a power struggle, but more a way to conserve time due to high volume of patients. Both professions work together and converse on proper tx for patients. After reading some of the above responses, I feel very lucky in that respect.

    Good luck to everyone in your various settings, and wish me good luck on my new start! 🙂

  • 50. shannon cornelson  |  July 2, 2013 at 9:55 am

    I am a respiratory therapist working in the education department in an acute care facility. I have a request from the rehab services department to do an inservice on respiratory therapy terminology and explain some of the basics about ventilator patients. Can any of you give me some recommendations on particular respiratory issues that may come up in your practice? I am just looking for some ideas on where to start. I am unaware of how much training you receive in school regarding respiratory therapy, and I don’t want to insult anybody by starting too basic. thanks!

  • 51. MS  |  July 26, 2013 at 8:36 pm

    In my acute care setting, I think it would be good to review the basics – alarms, when to notify the nurse, how to react when a patient begins to cough or desaturate, possible benefits of sitting up in a chair or repositioning in bed (i.e. increased lung volumes, etc.). Possibly reviewing what movements and exercises are safe to do with ventilated patients and the spectrum of movement possible in ventilated patients (such as sedated and ventilated versus awake and chronically ventilated). Basics are a good start because OT’s don’t often understand the ins and outs of ventilatory support. I think it would also be good to review what activity is to be expected immediately after extubation and when it’s appropriate to push the patient a little more with regards to activity. I used to be a PICU nurse before I became an OT. I know from working with my colleagues that many therapist are intimidated from the sheer volume of tubes, bells, whistles, etc. Hope this helps!

  • 52. Justin  |  July 4, 2014 at 2:16 pm

    Hi All,

    I am currently starting week 6 at a large trauma hospital. I am progressing as expected but so nervous still. I feel like I am forgetting what I learned in school and just overwhelmed with trying to pass fieldwork. I know I should not worry because I always did well in college. I am just finding a hard time during evals on what to do. I usually start by:
    -introducing myself and the role of OT.
    -ask about pain
    -quickly scan the room for important things (IV, NG tube, PEG tube, etc)
    -mobilize client to EOB
    -quick strength, ROM, sensation eval
    -THEN…I usually bring pants or socks to see how they can physically and cognitively complete the task. Sometimes people decline and I get stumped on what to do next especially if they are not getting up yet. Any thoughts on how to grade activities or back up plans. I am on a neuro floor!

    Thank you!!

  • 53. Anita  |  January 23, 2017 at 10:52 pm

    I am a OT in a small rural hospital where it has been a struggle to keep a full time OT. I recently took this position coming from a larger urban / trauma hospital and it has been challenging trying to get appropriate orders for OT. PT is the only service ordered for all Ortho patients included shoulders, THR, and back surgery patients. These are patients that would clearly benefit from OT. I have tried educating staff (RN, case managers, MDs) but many of the doctors are old fashioned and either do not value or really know what OT is. I feel OT has a strong value in acute care but many hospital including larger ones only hire limited OT staff compared to PT. I am really becoming frustrated with being overlooked and under-valued in acute care. I am really thinking of switching to home Health because I feel that OT would really be valued rather than treated like a CNA like in SNF and inpatient acute rehab settings. I really would like to hear some feedback from OTs who are working in home health.


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