Q: I think we underutilize occupational therapists at our agency. When is it appropriate to refer patients to OT?

Occupational therapists (OTs) are uniquely trained in the art and science of human occupation. This means they help patients engage in everyday life activities (American Occupational Therapy Association [AOTA], 2014). Areas of occupation are defined as: activities of daily living (ADLs) (e.g., feeding, dressing, bathing, toileting, personal hygiene), instrumental ADLs (e.g., medication management, shopping, meal preparation), rest and sleep, work/education, play/leisure, and social participation (AOTA, 2014).

In order to foster engagement in occupation, OTs address multiple factors that impact performance of occupations, such as sensory and motor skills, vision, cognition, pain, perception, endurance, activity demands, motivation, environment, support systems, values, routines, roles, and habits (AOTA, 2014). Occupational therapy interventions include restoration, prevention, maintenance, education, and advocacy, treating the whole person with a focus on individual priorities, needs, goals, and contexts. In one health policy analysis, occupational therapy was shown to be the spending category that reduced readmission rates for clients with heart failure, pneumonia, and acute myocardial infarction (Rogers et al., 2017).

The following case study helps to better understand when to make an OT referral: An independent 89-year-old man with atrial fibrillation and osteoarthritis was hospitalized due to an overdose of his anticoagulant medication. The patient was referred to the OT because he triggered multiple ADL deficits on the Outcome and Assessment Information Set (OASIS), and expressed fear of losing his independence. The patient presented as easily fatigued and complained of joint pain and difficulty sleeping. The OT completed a comprehensive assessment and developed a treatment plan that addressed performance goals related to self-care, rest, and instrumental ADLs. Given the reason for hospitalization, the OT also focused on medication management in terms of routine, cognition, and visual-motor skills. Cognitive testing indicated the patient had mild executive impairments, likely the major contributory factor for the medication error (the patient had been unable to make adjustments to his medication routine after the physician made a medication change). After collaborating with the nurse to share mutual perspectives and concerns, it was agreed that permanent support would be essential for safe medication management.

Here are some questions to ponder when considering an OT referral: Does the OASIS indicate difficulties with ADLs? Has there been a change from prior level of functioning? What events led to hospitalization (e.g., fall, medication error, frailty, cognitive decline)? Has there been a significant change in the patient's routines, habits, and roles due to loss of functional independence? Are caregivers stressed and in need of training and support? Are you noticing any safety concerns related to performance of occupations? Does the patient need assistance with meal preparation, laundry, or shopping? Would the patient benefit from adaptive equipment or environmental modifications? Does the patient have visual loss, pain, or significant physical impairments that impede independence?

Once you understand what OTs do, and formulate a picture of patient's needs, you will feel more confident in putting in a referral for occupational therapy services. Occupational therapy services positively impact interdisciplinary care and enhance patient participation, satisfaction, and clinical outcomes.

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