This blog began as a journal of a Winston Churchill Memorial Trust Travel Award visit to the USA to study how Lifestyle Redesign could be used in Occupational Therapy to improve the hospital/home interface for older people. It has continued to record developments and inspiration gained from that experience since returning from Los Angeles early in 2012.

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Sunday, 22 January 2012

Acute Hospital Visit

On Tuesday I had a tour round the acute hospital, the Keck Medical Center of USC, see this link for more information- as you can see the system run quite differently to the NHS.


Katie Jordan, Director for Occupational Therapy & Speech Therapy showed me round. Katie explained that she came into post about 3 years ago when the University of Southern California (USC) bought the hospital and the two amalgamated their services. Her role was to integrate the Occupational Therapy service with the Occupational Therapy teaching & research programmes at the University. As you will see form the website, the hospital services include very complex areas such as organ transplantation.
The Occupational Therapy service in the hospital covers in and out patients and operates a 7 day service. The familiar issue of prioritisation for in patients requiring OT was apparent, a prioritisation board is used in the OT office to plan the work and make best use of resources. Although the US medical insurance system is very different to the NHS, there is still the same concern about length of stay because a patient's medical insurance covers a set number of days for any particular situation or procedure, if a patient requires to stay in the hospital beyond this, the hospital begins to lose money....enter the OTs. The role in assessment and ensuring patients are at a level of function to allow them to return home safely is very similar to the UK.

We discussed the use of Lifestyle Redesign in the acute hospital context. A small scale trial (unpublished but presented at the AOTA conference) using Lifestyle Redesign with patients who have a Ventricular Assist Device has been carried out. There were optimistic results. The biggest challenge was incorporating this approach within the culture and 'regime' of an acute hospital setting. Using Lifestyle Redesign involves participants in making choices that fit with their lifestyle, this can be difficult in a hospital setting where, for example, there is no choice about meal times.
A new project has commenced with an OT working downtown in a Primary Care Centre (it sounds very similar to a GP practice in the UK). It is hoped that this will allow that OT to follow patients throughout their journey, including into the hospital, and this will allow further exploration and of Lifestyle Redesign across the continuum of care.

The principles of Lifestyle Redesign can begin to be applied, even in shorter, acute, episodes of care. One way is to expand on the Initial Interview/Evaluation process by being open to the person's occupational narrative and aware of the importance of 'storytelling' in framing occupation. There has certainly been a lot of interest in this area in the UK literature recently, although perhaps perceived as being more relevant from a mental health perspective that may mean those of us working in acute physical settings don't fully realise it's importance. I'd be interested to hear people's views on this...
Following this initial visit, I hope to be able to spend time with some of the OTs in clinical practice there- so spent the afternoon completing the online Health Insurance Portability & Accountability Act (HIPAA) training so I am covered re confidentiality- no escape from mandatory training! I will be able to report in more detail as my time here continues.

From this visit, a further conversation arose about the issue of electronic records. The hospital is in the process of moving to electronic records, these will include all disciplines, including the medical notes. We compared experiences and debated how the complexity of OT interventions can be captured in electronic notes, and also how to capture and document goals and outcomes. I think we both hoped the other would have the answer but of course we didn't, at least we share the same concerns.

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