Their Own Twist
Every facility has their own twist for what an occupational therapist might do,” says Marla Quinney, OTR/L, assistant director of Adult Inpatient Therapy Services at the University of Chicago (UC) Medical Center. Occupational therapists look at “how patients spend their days and ask, ‘What do they engage in and what do they not engage in because of the current condition?’”
The occupational therapist then helps to rehabilitate patients to baseline. “In an acute care facility,” says Quinney, “a lot of what we do is evaluation and then getting patients to the correct discharge disposition and follow-up care.”
Depending on the institution, occupational therapy offerings may involve management for range of motion, strength, coordination, and sensation; they also include therapy for activities of daily living (ADLs), such as self-care, home management, and community involvement, including vision retraining and cognitive and/or perceptual retraining as they relate to ADLs. Occupational therapists might also include management using assistive devices, and the provision of adaptive equipment. In some institutions, occupational therapy involves aspects of home evaluations, and feeding and swallowing therapy.
Working with Hospitalists: Challenges and Highlights for Occupational Therapists
Occupational therapists cite a few areas where hospitalists could provide more help to their fellow professionals in occupational therapy.
Distinction between occupational and physical therapists: To expedite care, hospitalists need to know whether to refer patients to occupational therapy or physical therapy.
“In general, a physical therapist would look at gross motor functions, which affect the patient’s ability to be mobilized from one place to another,” says Quinney. “This also includes whether or not they need assistance to do that safely, and then there’s a myriad of things they look at, including wound care, generalized weakness, and—with a general medicine patient—deconditioning, to make sure that they’re safe in their mobility. An occupational therapist looks more at ADLs, and what patients need to do in order to function in their daily lives and the safety associated with that.”
Timeliness of referrals: Quinney concedes that in the case of a patient who is deconditioned, it might be difficult to discern whether a patient requires occupational therapy or physical therapy. That is one reason why the timeliness of referral is important. If an occupational therapist receives a referral on the day the patient is scheduled for discharge, it may be too late to help them.
But referrals can also be made too soon, says Quinney, “because when the patient is in the ER being admitted, what’s needed may be something as simple as getting their fluids corrected, and once that’s done, then [occupational] therapy is no longer indicated.”
Another example of inappropriate referral timing, she says, might be in the case of a diabetic “whose blood sugars are too high or too low, and clearly, they’re not functioning at their premorbid level. But given the right intervention by the medical team, they’ll bounce back to their baseline.”
Other inappropriate referrals: A patient might also be assessed as having too high or too low a functional status to benefit from occupational therapy. For instance, “a patient might be at too low a level if they came from a nursing home for a UTI or some other complication,” says Quinney, “but their functional status is not something that a therapist would be able to impact in a short hospital stay once that medical problem is corrected.”
