If you are an occupational therapist navigating the dynamic landscape of an acute care hospital, you understand its distinct nature compared to traditional rehabilitation settings. Acute care is characterized by its rapid pace, moments of intensity, and continuous learning opportunities.
For those new to acute care, whether embarking on fieldwork or starting a new position, this article provides a comprehensive overview of the roles and responsibilities of occupational therapy practitioners in this environment, and what you can anticipate in your daily practice, particularly concerning common diagnoses encountered.
Understanding Acute Care Settings
Acute care refers to the inpatient hospital environment where individuals are admitted due to a sudden medical crisis demanding immediate and intensive medical intervention, or for a scheduled procedure or surgery.
The primary objective for patients in acute care is stabilization and treatment of their immediate medical condition. Subsequently, the medical team, including occupational therapy (OT), physical therapy (PT), and speech therapy (ST) as needed, collaborates to formulate a discharge plan once the patient is stable and ready to leave the hospital.
The patient population within acute care is diverse, encompassing individuals with a wide range of conditions, including:
Patients with Acute Medical Conditions: These encompass a spectrum of illnesses requiring urgent attention. Common diagnoses frequently seen by occupational therapists include stroke (cerebrovascular accident or CVA), heart attacks (myocardial infarction), respiratory failure, urinary tract infections (UTIs), diabetic ketoacidosis, and severe infections like pneumonia or sepsis. These conditions often lead to sudden functional impairments that necessitate immediate OT assessment and intervention.
Patients with Acute Surgical Conditions: This category includes individuals requiring surgery for conditions such as appendicitis, pancreatitis, burns, bowel obstruction, and trauma-related injuries. Post-surgical patients commonly experience pain, weakness, and reduced mobility, making occupational therapy crucial for regaining independence in daily activities and safe discharge planning. Diagnoses such as hip fractures and joint replacements are also frequently encountered, requiring specific OT protocols for recovery.
Patients with Chronic Medical Conditions: While acute care primarily addresses short-term medical needs, individuals with chronic conditions may require hospitalization for acute exacerbations. Common examples include worsening heart failure, chronic obstructive pulmonary disease (COPD) exacerbations, or acute kidney injury in the context of chronic kidney disease. Occupational therapists play a vital role in managing these exacerbations by addressing functional limitations and educating patients on self-management strategies to prevent future acute episodes.
Patients with Mental Health Conditions: Acute care hospitals also provide inpatient services for individuals experiencing acute mental health crises. Common diagnoses in this area include severe depression, psychosis, and suicidal ideation. Occupational therapy in this context focuses on providing a safe and structured environment, promoting engagement in meaningful activities, and developing coping mechanisms to aid in stabilization and transition to appropriate mental health services.
Patients with Complex Medical Needs: Individuals with complex medical needs, such as those requiring mechanical ventilation, emergency hemodialysis, or continuous intravenous medications, often require acute care hospitalization. These patients present unique challenges for occupational therapists, requiring specialized skills to address functional deficits while considering their complex medical status and numerous medical interventions.
The primary focus in acute care is not solely rehabilitation, but rather the medical stabilization of the individual. When occupational therapy is prescribed by the attending physician, the OT evaluates the patient to determine the appropriateness and potential benefits of OT services.
A significant goal for occupational therapists and certified occupational therapy assistants (COTAs) in acute care is to assist the medical team in determining the most suitable discharge plan for the patient. This may include returning home, home with assistance and home health services, transitioning to subacute rehabilitation, long-term acute care, inpatient rehabilitation, or other appropriate settings, depending on their unique circumstances and diagnosis. This discharge planning role is conducted alongside providing therapeutic interventions during their hospital stay.
The Indispensable Role of Occupational Therapy in Acute Care
Occupational therapists in acute care receive referrals for patients and conduct evaluations to ascertain their suitability for occupational therapy services.
While some patients are appropriate candidates for OT, others may not be due to medical instability or other factors. If a patient is medically stable and likely to benefit from skilled OT services, the therapist will initiate treatment. This involves establishing individualized goals with an emphasis on early mobilization whenever medically feasible.
The core objectives of occupational therapy in the acute care setting are:
- Comprehensive Functional Evaluation: To thoroughly assess the patient’s current functional abilities, encompassing self-care skills (Activities of Daily Living – ADLs), cognitive status, and mobility. This evaluation is crucial for understanding the impact of their medical condition and guiding intervention.
- Personalized Treatment Plan Development: To create a tailored treatment plan specifically designed to address the patient’s functional deficits and promote recovery. This plan is dynamic and adapts to the patient’s changing medical status and progress.
- Mitigation of Functional Decline: To proactively reduce the risk of further functional decline associated with hospitalization, immobility, and the underlying medical condition. Early intervention and mobilization are key strategies in preventing deconditioning.
- Enhancement of Functional Independence: To improve the patient’s functional independence through targeted interventions. This may involve retraining in ADLs, addressing cognitive or perceptual impairments, and improving mobility skills to enable greater self-sufficiency.
- Discharge Planning Expertise: To actively assist the interdisciplinary team in formulating a safe and appropriate discharge plan. Occupational therapists contribute valuable insights into the patient’s functional abilities, home environment, and support systems, ensuring a smooth transition from the hospital to the next level of care.
In addition to promoting early mobilization to prevent functional decline, occupational therapists, in collaboration with physical therapists, play a vital role in discharge planning. They continuously assess the patient’s progress throughout each treatment session to inform recommendations for the most appropriate post-hospitalization setting.
During therapy sessions, OTs may provide education on energy conservation techniques, address self-care skills, cognition, vision, functional mobility, and implement therapeutic exercises. Occupational therapists are also qualified to recommend adaptive equipment and home safety modifications as needed to enhance patient safety and independence upon discharge. These represent just a fraction of the diverse interventions that acute care occupational therapists provide within this dynamic setting.
Given the characteristically short hospital stays in acute care, often lasting only a few days, occupational therapists frequently recommend further rehabilitation services post-discharge if the patient’s functional level remains below their pre-admission baseline and continued therapy is deemed beneficial. For patients with extended hospitalizations, OT services are typically ongoing to address impairments and maintain functional abilities through targeted and occupation-based treatments.
Essential Precautions for Occupational Therapists in Acute Care
Safety is paramount in acute care occupational therapy practice. Patients in this setting are often medically complex and represent the least stable patient population compared to other healthcare environments. Their medical status, orders, and precautions can change rapidly and unexpectedly.
Prior to initiating treatment with any patient, a meticulous chart review is mandatory. This comprehensive review should encompass, but is not limited to, the following critical elements:
- Therapy Orders: Verify the physician’s order for occupational therapy, ensuring the appropriateness of the referral and any specific instructions.
- Laboratory Values: Scrutinize relevant lab values, such as complete blood count (CBC), electrolytes, and blood glucose levels. Abnormal values can significantly impact treatment planning and patient safety.
- Vital Signs: Review the patient’s vital signs, including blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature. These parameters provide crucial information about the patient’s physiological stability and tolerance for activity.
- Diagnostic Test Results: Examine results from pertinent diagnostic tests, such as imaging studies (X-rays, CT scans, MRIs) and electrocardiograms (ECGs). These results may reveal underlying medical conditions and precautions relevant to OT intervention.
- Weight-Bearing Precautions: Identify any weight-bearing restrictions, particularly for orthopedic or post-surgical patients. Adherence to these precautions is essential to prevent complications and ensure safe mobility training.
- Dietary Modifications: Note any specific dietary restrictions or modifications, such as NPO (nothing by mouth) status or special diets. This information is important for scheduling therapy sessions around meal times and considering patient energy levels.
- Code Status: Confirm the patient’s code status (e.g., Full Code, Do Not Resuscitate – DNR). This ethical consideration guides decision-making in emergency situations and respects patient wishes regarding life-sustaining treatment.
In situations where diagnostic uncertainty arises, or a refresher on lab value interpretation or a specific medical procedure is needed, readily available resources like online medical databases and colleagues become invaluable. Many facilities also provide readily accessible cheat sheets summarizing key lab values and medical information.
Regularly checking lab values and vital signs is of utmost importance in acute care, as patient status can fluctuate rapidly, potentially leading to significant clinical implications.
If your facility lacks a condensed reference guide, resources like online medical encyclopedias can provide helpful lab value interpretation guides. However, most hospitals typically have user-friendly “cheat sheets” available for clinicians to carry and reference during patient chart reviews.
Prioritize Nurse Communication Before Commencing Treatment
After completing the chart review and preparing for a therapy session, proactively communicate with the patient’s nurse to confirm their current medical status and clearance for therapy.
This step is crucial because the acute care environment is dynamic, and patient conditions can change rapidly, sometimes before updates are fully documented in the electronic medical record. Nurses, being at the forefront of patient care, often possess the most up-to-date information on patient status and any recent changes in orders or precautions.
Building strong professional relationships with nurses, as well as nursing assistants and other support staff, is highly beneficial in acute care.
Patients in acute care, particularly in intensive care units (ICUs), may have numerous medical lines, tubes, and drains. In the ICU setting especially, close collaboration with nurses and technicians is essential to ensure safe treatment delivery and prevent accidental dislodgement of any medical equipment during therapy sessions.
For therapists unfamiliar with various medical lines and tubes, readily available resources like online presentations with visual aids can provide valuable education on identification, purpose, and associated precautions for common medical devices encountered in the ICU and general medical-surgical units.
Common and Effective Occupational Therapy Interventions in Acute Care
Interventions in acute care are highly individualized and vary significantly based on the patient’s diagnosis, functional level, and medical status. An occupational therapist might be working on basic bed mobility with a patient on a ventilator with significant medical complexities, or providing shower training to a higher-level patient recovering from a hip replacement who is already mobile.
Considering the time-sensitive nature of acute care, with therapy sessions often limited to 10-30 minutes, common and impactful interventions include:
ADL Retraining: Foundational for Recovery Across Diagnoses
Practicing grooming or dressing tasks while sitting at the edge of the bed can be profoundly meaningful for a patient who has been unable to perform oral hygiene for days and needs to regain strength and sitting balance. These seemingly simple activities are crucial for restoring dignity and initiating the recovery process, regardless of the specific medical diagnosis.
Bedside commode transfers and toilet transfers are also highly functional and prioritized interventions, given their essential nature for independence and hygiene. Similarly, performing grooming or bathing activities at the sink effectively addresses standing tolerance and balance in a functional context, directly translating to improved independence in self-care for various patient populations.
A primary objective in ADL interventions is to incorporate mobility whenever feasible. Often, patients may only have opportunities to get out of bed with OT or PT sessions and remain bedridden for the remainder of the day. Integrating mobility into ADL retraining maximizes therapeutic benefit and promotes overall functional recovery, irrespective of the presenting diagnosis.
Caregiver Education: Essential for Successful Discharge After Acute Episodes
Caregiver education encompasses a broad spectrum of topics, ranging from post-discharge safety recommendations and information about the patient’s medical diagnosis, to guidance on accessing additional rehabilitation services. Providing clear and concise education to caregivers is crucial for ensuring a safe and supported transition home and promoting optimal recovery after an acute care hospitalization, particularly when managing ongoing conditions at home.
DME Recommendations for Home Discharge: Facilitating Independence in Common Diagnoses
Depending on the patient’s functional needs and diagnosis, recommendations for durable medical equipment (DME) for discharge to home may include items such as a tub bench, bedside commode, or hip kit (for patients post-hip surgery). Appropriate DME recommendations are vital for maximizing patient safety and independence in the home environment and are tailored to the specific functional limitations associated with their medical condition.
Hand Splinting: Preventing Complications Across Various Acute Diagnoses
Hand splinting is a proactive intervention used to prevent contractures, maintain joint integrity, and prevent skin breakdown through proper positioning. This is particularly relevant for patients with neurological conditions, burns, or prolonged immobility, where the risk of hand deformities is increased.
Exercise Programs: Creative Adaptations in the Acute Setting
In acute care, occupational therapists become adept at creatively utilizing readily available items for upper body exercises due to limited access to specialized equipment. Rolling a towel to serve as a dowel or using water bottles as weights for upper extremity range of motion (ROM) exercises are practical adaptations.
Chair or wall push-ups and sit-to-stand exercises from the toilet are also effective and functional exercises if the patient’s medical condition permits. Therapists learn to be resourceful and innovative in implementing exercise programs within the constraints of the acute care environment.
Addressing Specific Patient Deficits: Tailoring Interventions to Individual Diagnoses
Addressing patient-specific deficits is achieved through functional activities such as bed mobility training, bedside commode transfers, or supported standing with a walker to progress towards independence in dressing and toileting. Grading the activity to provide a “just-right challenge” is a key therapeutic principle, ensuring that interventions are appropriately challenging yet achievable for the patient, promoting progress and motivation across a spectrum of diagnoses.
Key Differences Between Acute Care and Traditional Rehabilitation Settings
The role of an occupational therapist in acute care differs significantly from that in other settings. The limited duration of patient encounters – typically just a few days – is a defining characteristic.
In contrast to acute rehabilitation settings where therapists have the opportunity to build rapport and work with patients over extended periods, acute care OT involves briefer, more focused interactions.
Instead of conducting comprehensive hour-long ADL retraining sessions as commonly practiced in rehabilitation, acute care OT emphasizes brief, functional interventions that yield immediate and practical benefits within the short hospital stay.
This approach is necessitated by the demanding workload of acute care OTs, who may conduct five or more evaluations in addition to providing treatments within a single day. Prioritization and efficient time management are essential skills. In addition to rapid treatment delivery, therapists must also efficiently integrate patient and caregiver education, particularly concerning discharge planning, often within very limited timeframes.
Despite the brief patient encounters, acute care occupational therapists make a significant impact on patients’ long-term recovery trajectories by ensuring they receive the most appropriate post-discharge plan from the acute care setting.
For a deeper understanding of the distinctions between acute care and inpatient rehabilitation, further resources are available discussing the specific roles of occupational therapy in various inpatient settings.
Is Acute Care Occupational Therapy the Right Path for You?
Acute care can be a demanding yet highly rewarding field of occupational therapy.
The challenges include managing a high patient volume, working with patients with multiple medical lines and devices, treating medically unstable individuals, and navigating the complexities of discharge planning to ensure optimal and safe transitions. The inherent stress can be amplified when discharge to the safest or most ideal location is hindered by factors such as insurance limitations, physician preferences, or family dynamics.
For new occupational therapy graduates considering acute care without prior fieldwork experience in this setting, it is crucial to seek out hospitals that offer robust mentorship programs for new clinicians.
Entering acute care without adequate mentorship is generally not recommended, given the steep learning curve associated with safety protocols, medical precautions, diverse treatments, and the intricacies of discharge planning.
New graduates with a strong passion for longer-term patient rehabilitation may find inpatient rehabilitation, outpatient therapy, or skilled nursing facilities more aligned with their professional interests. These settings allow for more extended engagement with patients and a greater focus on in-depth rehabilitation processes.
Occupational therapists in acute care, while not able to dedicate extensive time to patient rehabilitation, gain invaluable medical knowledge and clinical skills that are highly transferable and beneficial across all practice settings.
Resources for Further Learning in Acute Care Occupational Therapy
For those preparing to begin a position or fieldwork in acute care OT and seeking comprehensive resources, the textbook “Occupational Therapy in Acute Care” is a highly recommended reference. This textbook, collaboratively authored by experienced acute care OTs, serves as an invaluable resource for navigating the complexities of this practice setting.
This comprehensive book covers all essential aspects of acute care OT, including:
- Common medical conditions, diseases, procedures, evaluation techniques, ICU-specific considerations, body systems, infectious diseases, autoimmune disorders, dysphagia management, transplantation, and burn care.
Furthermore, the textbook includes critical information on:
- Interpretation of lab values, common diagnostic tests, medication considerations, altered mental status, low vision, bariatric patient care, vertigo management, safe patient handling techniques, pain management strategies, evidence-based practice principles, ethical considerations, discharge planning processes, and hematologic disorders.
In addition to comprehensive textbooks, for clinicians seeking a concise and readily digestible resource focusing on interventions and treatment ideas for acute care patients, an e-book resource dedicated to occupational therapy interventions in acute care is also available.
For ongoing professional development and to stay abreast of current trends and best practices in acute care OT, exploring additional resources such as professional organization websites (e.g., American Occupational Therapy Association – AOTA), online continuing education platforms, and peer-reviewed journals specializing in rehabilitation and acute care medicine is highly encouraged.
Want to learn more about OT in acute care?
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This overview provides a solid foundation for understanding the multifaceted role of occupational therapy within the acute care setting.
For experienced acute care OTs, what additional insights or experiences would you contribute to this discussion? Please share your thoughts and perspectives 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 last updated on May 6, 2024.
