Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. In acute care, discharge planning is a primary role of OT for clients with arm impairment after stroke. Discharge planning accounts for many factors, including impairments, function, social supports, insurance, and the input of other disciplines. This research aimed to (1) determine the agreement in discharge recommendations between OT and physical therapy during acute hospitalization and (2) determine the agreement of OT recommendation and actual discharge setting for clients with arm impairment after stroke. Primary Author and Speaker: Nicole C. Lam Contributing Authors: Kimberly Erler, Jessica Ranford, Jessica D. Asiello, Kimberly Cortina, Natasha Frazier, Abigail Rude, Caitlin Sadlak, Helena Thorne, Rachel Collins, Erin E. Donovan, Sarah Norris, and David Lin

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This qualitative, observational research study explored treatment encounters between patients with disorders of consciousness, rehabilitation practitioners, and family to understand how treatment decisions occurred. The data showed shared decision making (SDM) occurring as a process, meaning that not all five principles of SDM occur in one clinical encounter but rather unfold across multiple clinical encounters. We delineate differences in SDM between rehabilitation and the medical model. Primary Author and Speaker: Jennifer Weaver Contributing Authors: Trudy Mallinson, Leslie Davidson, Christina Papadimitriou, Ann Guernon, and Philip van der Wees

Date Presented 04/6/21 This study explores predictors of occupational competence and hospital readmission for clients with chronic conditions in acute care. Self-care function (β = 0.43, p = .01) and environmental impact (β = –.38, p = .01) significantly predict occupational competence. Functional cognition (OR = 2.19, p = .04) and occupational competence (OR = 0.81, p = .02) significantly predict hospital readmission. OTs should consider standardized measures of these predictors to facilitate successful discharge home. Primary Author and Speaker: Melanie Tkach Additional Authors and Speakers: John R. Patro, Emily Gavin

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study describes adults with intellectual and developmental disabilities (IDD) in the acute-care hospital setting and identifies differences in their experience compared with those of patients without IDD. Comparative analysis between the two samples revealed differences in the length of stay, insurance provider, discharge environment, and number of OT visits per day. This study affects the field of OT by increasing awareness of the utilization patterns of health care services for patients with IDD. Primary Author and Speaker: Samantha Conrad Additional Authors and Speakers: Molly Bathje, Matthew Medick, and Molly Ross Contributing Authors: Louis Fogg

This case report describes the distinct value of occupational therapy services in the treatment of a pediatric patient with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children in an acute care setting. Practice-based evidence was used to design the treatment plan for this patient throughout the course of his hospital stay. Interventions addressed range of motion, strength, functional endurance, activities of daily living (ADLs), instrumental activities of daily living (IADLs), and functional cognition. Occupational therapy goals focused on the progression toward return to baseline functioning and participation in ADLs and IADLs.

This case report examines the role of occupational therapy in the recovery of a client who became critically ill with severe acute respiratory syndrome coronavirus 2. In it, we describe evaluation and treatment methods, functional impairments, and special considerations when working with a client with severe coronavirus disease 2019 infection. The client was a 43-yr-old Hispanic man treated in a long-term acute-care hospital. Client-centered treatment sessions focused on activities of daily living (ADLs), self-feeding, medication management, and leisure and were implemented in 30- to 45-min sessions 3 times per week for 5 wk. The Activity Measure for Post Acute Care Daily Activities Short Form was used to measure basic mobility, daily activities, and applied cognition in the acute setting. A manual dynamometer was used to measure grip strength, and the Nine-Hole Peg Test was used to measure digit dexterity. Both were used in the context of occupational engagement. Data were collected at evaluation, every 2 wk, and at discharge. The client achieved his goals and demonstrated marked improvement in independence with basic ADLs, leisure activities, bilateral grip strength, and manual dexterity.

Importance: The number of adults with intellectual and developmental disabilities (IDD) seeking treatment in non–IDD-specific health care settings is growing. Little is known about how adults with IDD use health care services in specialty settings, including occupational therapy services. Objective: To describe adults with IDD in hospitals and identify differences in utilization patterns compared with patients without IDD. Design: Descriptive and correlational designs were used. Participants: Data were obtained from Vizient (Clinical Data Base/Resource Manager™), a national database of administrative discharge abstracts for adults admitted to hospitals for an orthopedic procedure. From this sample, subsamples of (1) patients diagnosed with IDD and (2) an age- and gender-matched sample of patients without IDD were identified. Results: The study cohort with IDD experienced longer lengths of stay, t(2821.5) = −14.2, p < .001; were more likely to have Medicare coverage, χ²(3, N = 8,472) = 1,170.38, p < .001; and were more commonly discharged to subacute or skilled nursing facilities, χ²(5, N = 8,472) = 1,033.60, p < .001. Differences in occupational therapy services were also noted. Conclusions and Relevance: Despite similarities in orthopedic procedures, participants with IDD had different use patterns than those without IDD. Differences may be attributed to varying client factors and contexts. The results also indicate that practitioners in non–IDD-specific settings should expect to encounter clients with IDD. Occupational therapy practitioners have an opportunity to be leaders in adapting treatment protocols and providing education to caregivers and health care providers on behalf of people with IDD. What This Article Adds: This article provides novel information about a population that is known to experience disparities in health outcomes. It offers a basis on which future research can build to improve health care delivery and occupational therapy interventions to improve outcomes.

The pandemic caused by coronavirus disease 2019 (COVID-19) highlighted the insufficient public health policies and lack of a national pandemic response strategy. Rehabilitation departments faced barriers to providing care in the traditional manner and needed to consider protection of patients and staff, staffing and personal protective equipment shortages, and uncertainty about best practices to address a novel health condition. This article highlights the strategies implemented by acute care occupational therapy leaders to support their staff; facilitate efficient care provision; and pivot with constantly changing policies, procedures, and research during the COVID-19 crisis. Occupational therapy’s distinct value in caring for this population and role in responding to the pandemic are shared to provide a guidepost for future health care crises.

Importance: Assessments that evaluate health care providers’ communication in acute rehabilitation settings remain scarce; this article contributes to the knowledge base. Objective: To assess the reliability and validity of the Clinical Assessment of Modes–Therapist version (CAM–T) from the provider’s perspective. Design: Cross-sectional, psychometric study. Setting: Acute care and acute inpatient rehabilitation. Participants: Ninety-six clients and 32 providers (occupational therapy, physical therapy, and nursing). Measures: The CAM–T was psychometrically evaluated using classical test theory and Rasch analytic approaches. Results: The findings offer strong evidence for the CAM–T’s reliability and validity for evaluating overall communication and adequate evidence for evaluating individual communication modes. Conclusion and Relevance: The CAM–T may be used by providers as a self-assessment of communication in occupational therapy and in associated rehabilitation professions. What This Article Adds: This article offers evidence in support of the CAM–T’s reliability and validity for evaluating health care providers’ communication with clients in acute rehabilitation settings. The CAM–T may be used to evaluate providers’ overall communication and individual mode use as described in the Intentional Relationship Model.

Importance: Changes in health care policy and payment over the past decade have resulted in a greater emphasis on cost effectiveness, quality outcomes, and the health care consumer’s experience. Payers’ response to the new policies and their expectations have created expanded opportunities for occupational therapy practitioners in health care overall but particularly in acute care hospitals. Objective: The objective of this article is to empower occupational therapy directors, practitioners, educators, and students to be proactive in a rapidly changing acute care setting. Evidence Review: Research on policy and payment changes since the passage of the Patient Protection and Affordable Care Act (Pub. L. 111-148) was synthesized with evidence related to occupational therapy practice and education. Findings: Occupational therapy practitioners in acute care environments are experiencing expanded roles in optimizing patient readiness for safe community discharge, decreasing lengths of stay, and protecting them from hospital-acquired conditions. Conclusions and Relevance: Policy and payment initiatives reward health care organizations for the added value occupational therapy practitioners bring to acute care teams. What This Article Adds: This article details how occupational therapy practitioners can advance consumer satisfaction, outcomes, and efficiency in acute care, which can lead to increased recognition of the vital role that occupational therapy can play, thus leading to expanded opportunities.

OBJECTIVE. We describe an educational intervention that involved simulation scenarios of medically complex patients to teach transfer training and promote clinical reasoning. METHOD. Scenarios were developed with practitioner input that described (1) a patient who was acutely ill, (2) a critical medical management event that occurred during a bed-to-wheelchair transfer of the patient, and (3) an occupational need. Transfer training, using the scenarios, occurred in a high-technology laboratory with SimMan^® and a mock hospital suite. Evaluation was based on student performance and perceptions of simulation effectiveness. RESULTS. On average, students completed 66%–88% of the transfer items correctly. Student performance suggested that the simulation scenarios were more difficult than practitioners rated them. Students rated the simulation scenarios as effective teaching tools. CONCLUSION. Scenario use in simulations for transfer training makes a positive curricular contribution to teaching procedural skills and clinical reasoning simultaneously.

Objectives. This study was conducted to obtain patients’ experiences in making the transition from an acute care hospital to their homes in the community. Method. Data were gathered through group and telephone interviews with a volunteer sample of 27 discharged patients. Analysis involved two stages: categorization of shared themes and interpretation of individual occupational experiences. Results. Informants described their experiences of transition in terms that were analytically categorized as Perceived Self-Efficacy, Resources, Dimensions of Occupation, and Environmental Constraints and Opportunities. Analysis of individual patient transcripts suggests the presence of an hierarchical ordering of desired occupations. Conclusion. Understanding patients’perceptions of enabling and disabling experiences has implications for predischarge and postdischarge practice in occupational therapy.

Objectives. Occupational therapy directors need to recruit and retain therapists to ensure both the delivery of high-quality services and the viability of their departments. At present, research on the recruitment and retention of occupational therapists is limited; recruitment and retention strategies can be cited, but their utility and effectiveness have not been determined. Method. A survey was designed to identify the recruitment and retention strategies used in various practice settings and the perceived level of effectiveness of those strategies that were used. The surveys were mailed to 500 occupational therapy directors. Once the sample size was adjusted to exclude non-eligible subjects, the eligible sample size was 471. Of these, 320 (68%) were usable. Results. Ten of the 23 recruitment strategies listed on the survey were used by more than 70% of the respondents. The top three recruitment strategies were staff member referrals, professional development opportunities, and newspaper advertisements. Seventeen of the 23 retention strategies listed on the survey were used by more than 70% of the respondents. The top three retention strategies were interpersonal staff member relationships, employee appraisals, and continuing education. Conclusion. Findings suggest that occupational therapy departments’ recruitment and retention plans could be improved by expanding the number of strategies used and by incorporating techniques that appeal to a broader range of therapists.