Monday, April 13, 2015

A Day in the Life | Acute Care OT

Here's a little known fact about me: I worked in acute care my first year as an OT. I loved reading this "day in the life" submission, because it brought back so many memories! I forgot how much I enjoyed the acute care setting! That's one of the things that drew me to OT-the ability to work in a variety of settings. And David's tip at the end to document after seeing two patients? I completely agree!

I love meeting social media friends in real life and I was lucky enough to meet David last year at the AOTA Conference. David was an emerging leader for AOTA and is truly passionate about the field of OT. I also discovered that he has a charming accent, so when you read this one, be sure to do so with a Southern accent!

I arrive at the hospital around 7:15-7:25 and from that point forward I am reviewing and updating the patient list (checking to see if patients have been discharged or moved) and then doing chart reviews on new evaluations. After this my day is up in the air. I usually hit the floor anywhere between 8-8:30 and begin evaluations. Whenever I go to visit patients I always check with the nursing because the orders and/or notes are not always current.  You can usually get a good clinical picture of a patient by the notes, but I’d rather be safe than sorry.

The hospital has a stroke protocol in which every patient must be seen in the first 24 hours unless tPA is given in which the patient is on hold for 24 hours (click here for more information on stroke treatment). Those are usually the first patients I try and see. Some of the stroke patients are under observation and those are fairly quick evals, because they did not have a stroke or their symptoms have resolved and they are back to their baseline.

I will then move to completing the orthopedic evaluations. The majority of times this usually means I am visiting the Surgical Intensive Care Unit (SICU) and completing the evaluations. These take a while because pain is a major factor as well unhooking the patients from the monitors. However, before I do anything with these patients I will always check with nursing to make sure there are no holds for the patient or the patient is able to participate. There is a great PT that I work with that has been instrumental in helping me become comfortable in the ICU. I usually ask her a lot of questions and on occasion we will co-treat depending on patient needs. 

I usually take lunch 11:30-12:30 with a minimum of 30 minutes for documentation. Sometimes it takes me 30 minutes and sometimes it takes longer. I don’t really have a goal for a number of patients that I see in the morning. I usually have 1-2 missed visits due to the patient being off the floor for tests, on hold, or they refuse. My goal for when I take lunch is to have double digit units, 12 is ideal, but it doesn't happen everyday. 

After lunch I will check to see if there are any new orders and begin again. This is usually when I get to do treats. I try and treat for 15-20 minutes depending on patients needs and diagnoses. Treatments usually consist of patient/family education, ADLs, training with adaptive equipment, strengthening/endurance, fine and gross motor activities, and neuro re-education. 

I usually have 3-4 visits in the afternoon. After I finish my afternoon documentation, I update our patient list and update the magnet board in the office. I clock out between 3:30-4. That is somewhat my typical day.

In acute care you have to be flexible. There are days where I only complete evaluations all day and there are other days where I complete 1 or 2 evaluations and the rest are treatments. The productivity for an 8 hour shift is 7-8 visits and 18 units.  There are days where I have had more missed visits than I do treats. The days vary and that's just part of the setting.

A word of advice…I volunteered with an acute therapist when I was in school and she told me that she always documents after seeing two patients and I’ve done that since moving into acute care. Documenting takes anywhere from 5-10 minutes with a treatment and 10-20+ for an evaluation depending on the diagnosis and/or patient’s functional status. My goal for documentation is for anyone who reads my note, whether it be the MD, RN, PT, Case Manager, or another OT, they know exactly how that patient performed during my treatment or evaluation. I want them to have enough information that they feel they were in the room with me.

About David:
David works at Saint Thomas Midtown Hospital in Nashville, Tennessee. David primarily works in acute care, and occasionally dabbles in inpatient rehab when needed. David was in the 2013 Emerging Leaders cohort for AOTA and is currently serving on the Emerging Leaders Development Committee. If you have questions about AOTA's Emerging Leaders Program, David is your guy! The 2015 AOTA Conference is in David's hometown, be sure to look him up if you'll be there! 

Connect with David:
Twitter: @davidsmcguire
LinkedIn: David S. McGuire

AOTA Conference Presentations:   

Saturday, April 18:
  • 8:00-9:30am-SC 303: Advance Your Social Media Strategy: Ideas for Web-Savvy OTs
  • 12:00-2:00pm-PO 7020: Functional Leadership: Engaging the Everyday Practitioner

1 comment:

  1. David, This is a wonderfully insightful blog that truly tells the story about the organization and time management skills that ALL OTs need to develop. I love your compassionate viewpoint about being ethical and checking with nursing and other staff before approaching patients. Your sense of knowing the limits of what you can and cannot control is most like one of the facets that brought you to be an emerging leader! Thanks again for this look into your day.


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