week 1 = DONE!

Today I finished my first week. There are still things I need to work on (like understanding which direction to head in the parking garage - sometimes up is the right answer even if I'm trying to get to the bottom..., how to get around the hospital, how to use the computer systems - yes, there are 2 we use for documentation, so it's confusing), but overall I feel really comfortable there. I got a great review for my first week, and talked about some things to continue to work on/learn about. 

I didn't go into my placement thinking I would like working in orthopedics, but I'm actually really enjoying my placement. The thing about Cleveland Clinic is that even something as "simple" as a hip replacement or a knee replacement isn't typically simple. We have lots of patients that have other medical conditions, are having a surgery done that other doctors declined to do (sometimes due to risks or the nature of the procedure), and some patients are having things fixed that were initially done incorrectly by other doctors. A lot of my patients are "revisions" which means they have already had a surgery and are having this redone. Quite a few of those take place when the original implant (new hip, shoulder, knee, elbow fixators) are infected. Doctors typically take out the infected implant and then put a spacer in to fill the area while they fight the infection. I thought this would be a specific or specialized piece, but most of the time it just looks like a disc. They are filled with antibiotic to help fight the infection right at the source to make sure all of it is gone before attempting a new joint.

I like that the end result is hopefully all the same - returning to prior level of function - for some of my patients that means they don't need OT after the initial evaluation. Other patients require visits from us while they are in the hospital as well as home OT or OT at a nursing/rehab facility. We get to make the recommendation as to where patients should go after release from the hospital based on the needs they have and the help they can get at home. I'm starting to feel more comfortable that I can make an educated decision about what would be best for the patient after discharge.

I spent a good portion of the week working on getting into the routine. I get into work each day and pull Joy's schedule (my supervisor) and then start on my chart reviews. Since we're working in acute OT our patients change very often and we typically don't know who we will have on our schedule the next day. I'm starting to learn how to read x-rays, doctor's orders, notes from other services (the MDs, nursing, other therapy), and understanding medical conditions, and tests (I actually know what it means when someone does blood work and what those numbers actually help tell us). I'm learning about how we bill insurance companies and private patients. I'm also spending a good deal of time working on my documentation skills. We use one program at the hospital for OT/PT charting, while the rest of the hospital uses a different program. The main program used is important for us to use to understand what else is going on with the patient besides just therapy. There are so many steps to charting, billing, assigning patients, etc - it's crazy! It takes up almost as much time as actually seeing patients. 

Our goal is to have about 5 billing credits per day - we haven't accomplished that yet (since each 15 minutes counts for .25 billing credits), but with all of the training my supervisor has to do with me I think we're doing pretty well. I'll keep you all posted on how things keep going.

I'm looking forward to sleeping & getting work done this weekend - and next weekend seeing my SNA!!