OT Settings Series: Acute Care Occupational Therapy with Emily Saucier

Did you think that OT Practitioners can only work at hospitals? Think again!

Next up on our #OTSettingsSeries is Emily Saucier, OTR/L. Emily Saucier, OTR/L graduated with her masters in OT from Rockhurst University in 2016. Emily splits time between 2 urban Level 1 Trauma Centers in Kansas City. When not working, Emily enjoys spending time with her husband, 2 littles, and big dog Arnold. She loves reading, traveling, and speaking Spanish any chance she gets!

MEET EMILY

• Graduated: 2016
• Settings: Acute Care, ICU, program development in NICU

Shannen: Hi Emily, can you please describe your setting? Who do you work with as far as interdisciplinary colleagues? Is your setting one of its kind or is it a standard hospital?

Emily: I primarily work at an urban safety net hospital in downtown Kansas City. We are a Level 1 Trauma Center and serve an economically and culturally diverse population. We staff 8 full time OTs and office/collaborate closely with our PT and SLP colleagues. We also work closely with nurses, social workers, and residents in daily rounds, informal communication, and calls/pages regarding patient safety and therapy recommendations.

Shannen: Who benefits from OT services in your setting? (Specific to a certain population? Describe a “typical patient” in your setting? Who qualifies to receive your services?

Emily: As the safety net hospital in our county, we are often the first stop for the uninsured and underinsured. A relatively large portion of our patient population lacks secure housing. We also frequently work with immigrant populations and offer in-person interpreters in Spanish, Arabic, and Swahili. In a word, our patient population is diverse. We typically have a lot of trauma patients on caseload, as well as those experiencing exacerbations of chronic diseases. To me, our hospital is a fantastic place to practice OT, considering the complexity and layers that contribute to each patient’s occupational makeup. There is never a lack of interesting stories or opportunities to connect with patients.

Shannen: What value does OT bring to your setting? Can you describe what OT brings to the table in acute care?

Emily: ADLs and discharge recommendations are the name of the game in acute care. When physicians or social workers reach out to us, it is largely about self care and safety; “can this patient go home?” or “are they more appropriate for rehab or SNF?” That being said, I think OTs are uniquely positioned to take in the “whole person” when determining these recommendations. At times, other professionals are so laser-focused on their scope that they may miss the big picture. By taking time and getting to know these individuals, we have more depth of understanding on which to base our recommendations.

Shannen: How do you describe occupational therapy to a new patient in your setting who asks “what is OT for me?”

Emily: In acute care, I typically introduce myself as OT and then say “doctors asked us to come work with you to make sure you are able to take care of yourself just like you do when you’re not in the hospital.” While this is an over-simplistic definition compared to other settings, it is an immediate segue to obtaining prior level information, and the emphasis of OT in acute care truly is largely on ADLs.

I also make sure to ask about hobbies and meaningful activities (a tip I learned from a more experienced therapist): “what do you like to do when you are well?” This helps build rapport, guide treatment, and understand patient motivations.

Shannen: What does the duration of acute care occupational therapy services look like?

Emily: In school, we learned that acute care stays are very brief (1-3 days) but that is not my experience in my setting. Post acute planning is complicated for these patients, and we often work with patients for days, weeks, and yes, even months at a time. This is equally a blessing and a challenge! Because our department emphasizes continuity of care, I manage priorities on my caseload day in and day out; therapists are also largely responsible for shepherding individual patients through this process. We strive for daily treatment sessions, but the reality of our numbers means that patients are often staggered throughout the week.

Shannen: What certifications or specialties do you have? What unique interests do you have?

Emily: While I don’t have specific certifications, I have pursued CEUs and mentorship from teammates to build up my competency in the ICU. I am also part of a team developing a NICU therapy program in our hospital. Our department is relatively small and encourages specialization; our staff are currently piloting specialties in pelvic floor and oncology rehab, among others.

Shannen: Describe a moment in which you felt like you facilitated a positive change in your patient’s life or trajectory of functional recovery?

Emily: In acute care, we lay the groundwork and make the first steps in the rehabilitation journey. Often we send patients to the next setting when there is much progress left to be made. On the rare occasions when patients return for an update or for outpatient services, they are often unrecognizable to us. And although they frequently don’t remember us at all, knowing that we intervened at the foundational level of their recovery is so meaningful to me. Beyond that, I frequently have patients say things such as “thank you; I feel so much better; I feel like myself again” after working with me.

Done right, I think OT can inject autonomy and dignity into a hospital stay– and in many ways, a hospital stay robs a patient of both. Self care may not be rocket science, but it is so very valuable in this setting.

Shannen: What things do you not like about this setting? What would you like to change?

Emily: Like all healthcare workers, we operate within a system that sometimes feels driven by financial considerations versus patient care. Particularly with our uninsured population, there’s such limited options for post acute care and therapy. It’s difficult to have a sense of what the patient needs versus what the patient will be able to get. While widespread change will require advocacy at a system-wide level, we work to be creative and assertive when advocating for our patients on a case-to-case basis as well.

Another challenge of acute care is that therapy competes with many other priorities in a patient’s day. We have to be flexible in our scheduling and gracious with other providers. Some days everything runs smoothly and some days it feels like there’s not an available patient to be found!

Shannen: How did you “get your foot in the door” to work in this setting?

Emily: After a very brief stint in pediatrics, changes in my personal life led me to look for more flexible employment opportunities. My only experience with acute care was a weeklong level 1 fieldwork; however I interviewed at the same hospital where I completed my level 1 and whatever memories they had of me were positive. 🙂

I was enthusiastic in my interviews with management and peers and addressed questions as to how I would build my knowledge and confidence in this setting. They were willing to hire me knowing I would need training and mentorship, and I took advantage of the wealth of knowledge and training (formal and informal) my OT department provided me. 

Shannen: Where do you see yourself in 5 years? 10 years? How does working in this setting help you reach your personal professional goals?

Emily: I can see myself working in acute care for a long time. There is so much room for growth and specialization within this setting. I’m eager to continue to work on program development, contribute to improvements in our departmental processes, and explore opportunities to represent OT in this setting.

Shannen: What specific “special skills” are recommended to be successful in your setting of acute care at a Level 1 Trauma Center?

Emily: I can’t emphasize enough how essential knowledge of medical conditions is in the acute setting. Acute illness, comorbidities, lab values, and vital signs need to be taken into consideration as they impact treatment and outcomes. This knowledge also enables OTs to communicate effectively with other medical professionals. I had to independently develop knowledge beyond entry level to become effective and efficient in chart reviewing and written/verbal communication. Safely negotiating lines, wires, and alarms, and medical equipment is an additional specialized and essential skill for acute care safety and success!

Shannen: How do you deal with grief, illness, sadness, loss, caregiver burden…etc in your setting? (What psychosocial interventions…who do you refer your patients to….how do your prevent burnout and maximize your own self care and occupational balance??)

Emily: What distinguishes acute care from other settings is (surprise!) the acuity of the illness/injury. We deal with a range of novel and challenging situations in which people find themselves: from a former elite gymnast with a life changing spinal cord injury, to someone who just learned that their cancer has spread, to a patient who survived a car accident only to learn that their loved one did not. We are witnesses to patients’ physical and emotional pain, and for some patients, we are on the ground floor of rebuilding what life looks like in the “after.” I consider this a privilege, and I don’t take the responsibility lightly. That said, I strive to be present and meet my patients where they are. I try to listen to their grievances and be patient with their quirks. I celebrate their victories both minor and major, and I try to balance what I think is best for them with their right to autonomy and control. At the end of the day, I try to leave work at work and be present with my family, although some days this is easier than others!

Shannen: Advice you would give to someone thinking about / wanting to work in your setting? What do you wish you knew about this setting x years ago (before you started)?

Emily: I remember telling my fieldwork coordinator I was open to “anything except acute care” because I was nervous about the acuity of illness and I was certain it would gross me out! And I’ll admit that some situations truly are “gross.” However, I wish I knew then the benefits of acute care work: I love the autonomy of planning and managing my own day and caseload. I have much more flexibility in structuring my day and treatments versus other settings. I can spend 10 minutes or 60 with a patient depending on priorities and needs. And while we are productivity-driven, the emphasis is lesser than in other settings. 

With regard to the degree of illness and my proclivity to anxiety, I actually feel safer operating in the acute care world versus other inpatient settings. The patients are attended to by a multidisciplinary team, and I have the hospital resources just a button or shout away should something feel off or unsafe. Patients benefit from closer monitoring here than in other settings.

My advice to therapists considering this setting is twofold.

1) Go for it!! Don’t be scared off as I was initially.

2) Access your resources to become competent and confident in acute care. Ask questions! Even if you feel they are silly, asking thoughtful questions only reflects well on you. Google is your friend. Your colleagues and office-mates are your friend. Nurses are your friend. Present yourself as confident and knowledgeable, but please don’t hesitate to ask for help as needed.

Want to connect with Emily?

IG: @emoxysaucy

Blog: emilysaucier.wordpress.com

Questions? Comments? Feedback!! Please consider posting below!! Follow the hashtag #OTSettingsSeries on Instagram to never miss a post:)!!

Finally, a happy thank you to Emily for sharing a glimpse of her acute care OT world through her unique lens!

With kindness,

Shannen Marie OT