My foray into acute care was bumpy. After a stressful fieldwork II experience at a hospital, which I barely passed, I swore off acute care, telling myself I just didn’t possess the natural abilities needed for it. I came back to it later after having two years of experience at a SNF, which provided me with some medical knowledge and confidence as a therapist. I applied for per diem positions for a full year before finally getting hired.
In the hospital, you are part of the medical team consisting of many healthcare professionals, which is responsible for treatment and safe discharge of the patient. In the hospital, a therapist’s role is primarily acting as a movement specialist and preparing the patient for an appropriate discharge placement. Here are members of your team, their roles, and how you can help as a therapist. Nursing Role in a nutshell - Responsible for a patient’s wellbeing and executing doctor’s treatment orders while in the hospital.
Before you work with a patient, chart review the vitals range set by the doctor in the patient’s managed orders. The appropriate vitals range will vary from patient to patient. For example, stroke patients may be given permissive hypertension ranges whereas aortic aneurysm repairs may have a lower systolic BP limit. Eventually, you will begin to learn which diagnoses typically have special vitals parameters. Vital parameters may also be written in the physician notes and not updated yet in the managed orders, so it is important to contact the medical team if the orders are not consistent with the doctors notes.
I was engaged with about 5 months or so before my wedding date and was working in the ICU. There was a lady in her 20s admitted to the hospital because an organ was failing and she needed medical support while waiting for an organ transplant. As that primary organ failed, other organs started having issues as well. She was intubated and placed in a medical coma. The day I saw her for an evaluation, she was extubated and the doctors started weaning her sedation.
*All opinions are my own and may not represent the experience of others. As with any job, the hiring manager prefers an employee that: 1.) Will get up to speed on job duties quickly and won’t require much additional training from staff 2.) Will provide safe and effective care 3.) Will help fulfill the needs of the rehab department 4.) Will be a good cultural fit for the therapy team
What skills are needed working in a hospital vs working in skilled nursing or home health? In acute care, the OT role is much the same, evaluating a patient for OT needs, making a treatment plan, progressing a patient to increased independence, and caregiver training. The goal is slightly different. The goal of an acute care therapist is to work with the medical team to expedite a patient’s discharge out of the hospital and to reduce the likelihood of readmission due to the inability to perform ADLs safely or adequately at home.
*Every hospital has different practices, so check in with your supervisors and coworkers on how your location triages. There are some principles that generally apply across the board. The primary thought process is that you want to prioritize patients to make the hospital more efficient with discharges and admits. Discharge Pending Patients The most important patient to visit first thing is the one that is ready to discharge but is just waiting for therapy to see them.
(If you’re using EPIC for documentation, the kardex will give you an idea of what lines patients have before you walk into their room.) In line management, a few principles apply: Most critical lines on top, lines oriented towards the side you’re moving to. It also helps if nursing can disconnect any lines before your therapy session. Common lines for medication administration IV line PICC line Central line AV fistula (for dialysis) Note about lines on the patient’s arms: There are some considerations you should take before taking BP readings:
The hospital is a potential germ infestation ground with sick patients flowing in and out of it’s corridors everyday. It is important to protect yourself and your patients from cross contamination. Every hospital has their own guidelines for sanitation. Here is a generalization of what you might see. General hygiene: “Gel in, gel out” - Rub hand sanitizer over your hands before you enter the room and after you leave room.
Here are some important steps to chart reviewing. 1.) Check to see that there are active OT orders from the doctor before seeing the patient. 2.) Why is the patient here and what did the doctors do or what are they doing to address it? Sometimes doctors are still working up a diagnosis or the patient has not yet received their procedure. It is preferable to see the patient after they’ve been treated.
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