FIONA STANLEY HOSPITAL

ACUTE CARE SERVICES

Haematology and Oncology

The Occupational Therapist in Oncology and Haematology works with a complex caseload of adults attending
Fiona Stanley Hospital inpatient ward and outpatient cancer centre with any oncology or haematology
diagnosis. Diagnoses include malignant neoplasm of body parts such as prostate, brain, spine, breast, lung,
uterus and liver; leukaemia, lymphoma and myeloma. Generally assessment involves review of performance
components and occupational performance in activities of daily living, physical, functional and cognitive
performance, as well as verbal assessment of their home environment and social supports. Evidence based OT
interventions provided to this cohort include palliative discharge planning, education on energy conservation
and fatigue management, education on cognitive compensatory or remediatory strategies, chemotherapy
induced peripheral neuropathy, sleep hygiene, delirium management, falls prevention, ways to manage
breathlessness, wheelchair and equipment provision.

4C Cardiothoracic and Vascular

Ward 4C is the acute Vascular and Cardiothoracic surgery ward. There are 24 beds in total and the caseload
fluctuates between specialties, generally 15 beds allocated to cardiothoracics and 7 beds to vascular. Common
vascular diagnoses include diabetes, peripheral vascular disease, necrosis/ ischaemia, foot ulcers, toe
amputations, below knee amputations and above knee amputations. Common cardiothoracic diagnoses include
Coronary artery bypass graft (CABG), Myocardial Infarction (NSTEMI, STEMI), Angina, Ischaemic Heart Disease,
Stroke, Acute coronary syndrome and Mitral/ aortic valve replacement (MVR/ AVR).

4D Coronary Care Unit (CCU) and Cardiology

The CCU provides critical cardiac for patients requiring support, monitoring and treatment, for life threatening
or potentially life threatening cardiac conditions. There are 20 beds and a 1 nurse to 2 patient ratio. The team
comprises of two specialties, cardiology and advanced heart failure service (AHFS). Common cardiology
diagnosis include STEMI, NSTEMI, cardiogenic shock, heart failure, Acute Coronary Syndrome, atrial or
ventricular arrhythmias, valvular disease and cardiogenic pulmonary oedema. Common cardiac interventional
procedures include; Transcatheter Aortic Valve Implantation and coronary artery stenting. The AHFS specializes
in the management of acute and chronic advanced heart failure in both the inpatient and outpatient settings.
The Advanced Heart Failure and Cardiac Transplant Service (AHFCTS) provides Western Australia’s state service
for cardiac transplantation and mechanical circulatory support including left ventricular assist devices (LVADs).
The service has particular expertise in cardiac (endo‐myocardial) biopsies and right heart catheterization. Ward
4D Cardiology: provides specialty cardiology care to supports patients with similar cardiac conditions as the
patients in CCU, but who require a less acute level of care and monitoring. Ward 4D can be thought of as a ‘step‐
down’ for some cardiac patients who have come from CCU, and is often a place where short term inpatient
rehab and ongoing allied health input takes place.

The OT role on these wards is to maximise independence and function in the person’s essential activities of daily
living post cardiac event or with their cardiac condition. A large proportion of the OT role is to provide education
on stress management and energy conservation strategies, assess cognitive functioning, support pressure care
and specialised seating needs and provide rehabilitation. The OT also and provides a weekly education talk as
part of the cardiac rehabilitation service.

5C/5D Renal, Respiratory, Gastroenterology and Infectious Diseases

Renal: Patients admitted under the renal team, have newly diagnosed and pre‐existing renal impairment, with
other medical complaints. The role of the occupational therapist in renal is to focus on facilitating independence
and maximising function in the person’s essential activities of daily living with patients who experience a chronic
or acute renal impairment. The ultimate aim of OT on renal is to enable people to return home as safe,
independent and functional as they were prior to their admission.
General occupational therapy input provided:
- Functional review and appropriate equipment provision to enable independence

FIONA STANLEY HOSPITAL OCCUPATIONAL THERAPY PLACEMENT DESCRIPTIONS |

 - Cognitive review and intervention as required (delirium management strategies, further cognitive
assessment, education)
- Education on energy conservation and fatigue management for dialysis patients
- General discharge planning
- Pressure management and education
Ward 5D has 24 beds which services the acute respiratory, advanced lung, gastroenterology and infectious
diseases specialties. Common diagnoses include; Chronic Airflow Limitation, Bronchiectasis, Chronic Obstructive
Pulmonary Disease, Asthma, Carcinoma of the lung, Cystic Fibrosis, Pneumonia and Pleural Effusion.

The OT role on these acute wards is to assess function, cognition and pressure care and provide interventions to
optimise a person’s function to return home. Common roles include functional assessments, wheelchair
prescription, Kitchen Assessment, Cognitive Assessments‐ MoCA, Cognistat, CAM, RUDAS, KiCA, Initial
Neurological Screens, Equipment prescription, Home Assessment and referral, Pressure care assessment and
prescription, education on energy conservation and activity pacing.

General Medicine (Ward 6C, 6D) and Intensive Care Unit (ICU)
General Medicine provides care for patients with a broad range of medical illnesses, chronic disease and medical
conditions that are not clearly differentiated. Common medical issues include falls, increased
confusion/delirium, UTI, pain, respiratory illness (shortness of breath/COPD) and functional decline (difficulty
mobilising, poor self‐care). Patient’s usually come from either home or residential care. There is limited
involvement with residential care patients unless specifically referred (i.e. pressure care, wheelchair). There is
also an increasing number of <65 patients with multiple issues being transferred to these wards for complex
discharge planning (ie, NDIS, accommodation issues). 6C and 6D operates in a Transprofessional Model of
Practice between OT and Physiotherapy.
ICU provides tertiary‐level planned services for the management of adults requiring post‐operative intensive
care, as well as emergency services for adults with life‐threatening illnesses, injuries or complications.

SRS 2A – Geriatrics
SRS2A or the acute care of the elderly (ACE) is an acute geriatrics and general medicine ward with 16 beds. The
geriatric patient cohort are over 65 years of age, and often experience multiple co morbidities impacting on
their ability to return home. Common conditions and diagnoses include dementia, delirium, falls, fractures,
neurological conditions (stroke, Parkinson’s Disease, multiple sclerosis), pneumonia, respiratory and cardiac
conditions (exacerbation of COPD/CCF), general infections, pressure injuries, chronic and/or back pain, decline
in function/cognition, and social admissions. The focus for these patients is enabling discharge as early as
possible and linking patients with the appropriate community resources/services to continue assessment and
treatment in the home.

ACE is staffed under a Transprofessional Model of Practice (TPP) ‐ skill sharing across professions rather than
“ownership” of skills according to profession. TPP is different to inter‐professional team practice as it recognises
that multiple professions can perform the same generic skills rather than working as part of a team to
contribute a specific skill according to historic roles. Any patient that requires a discipline specific skill will still
be referred to the appropriate discipline. Transprofessional practice does not negate the need for and use of
the specialist skills of each profession.

Frailty Assessment Unit (FAU)

The FAU is a 12 bed unit under a Geriatrician for patients over the age of 65 with complex medical and social
needs. The Frailty Unit is a high turnover transdisciplinary ward, with the aim of completing a comprehensive
assessment on day one of a patients inpatient stay. The Frailty Unit follows a CHOICE framework (Consider
Home Over Inpatient Care Every time) with the focus on enabling patients to be discharged home as early as
possible and linking them in with the appropriate community resources and services to continue assessment
and treatment in the home. You will be working closely with the Physiotherapist and Social Worker on the ward

FIONA STANLEY HOSPITAL OCCUPATIONAL THERAPY PLACEMENT DESCRIPTIONS |

with some shared basic assessments and intervention. We work in partnership with our patients and their
families to engage them in the discharge planning process, with a strong focus on the patients’ perspective and
shared decision making.

Emergency Department (ED)

Within the Fiona Stanley Hospital emergency department Occupational Therapists work as part of the
multidisciplinary service to assess and treat patients who present to the adult or paediatric emergency
department of Fiona Stanley Hospital. The allied health team consists of OT, PT and SW. OT and PT work within
a transdisciplinary model of service provision to:
 Facilitate safe and effective discharge for patients that do not require admission for medical reason;
including falls, decreased functional mobility and mild traumatic brain injuries.
 Prevent unnecessary and/ or inappropriate admissions to Fiona Stanley Hospital, by using discharge to
assess principles.
 Reduce length of stay and best patient outcomes by providing early intervention and continuation of
care to patients who require admission
 Collaborate care with community and hospital based services for patients to prevent the same.
The OT role within the emergency department focuses on the assessment, intervention and discharge planning
for patients with; acute cognitive changes (including mild traumatic brain injuries and acute delirium), falls,
difficulty completing ADL function, general geriatric conditions, pressure injuries and finger based injuries.

Mental Health
Mental health OTs work closely with patients, along with their significant others and services, to assist them to
manage adverse life circumstances and mental health symptomology more effectively. OTs work alongside
patients to assist them to successfully manage stressors, develop resilience and enhance skills to enable them to
cope with the complexities of daily life. At FSH we work alongside patients across the developmental spectrum
from adolescence and young adults, to new mothers and adults in various stages of their recovery journey. We
provide specialist mental health input (individual and group therapy) in these areas with a strong focus on
functional recovery/development to enhance patients ability to engage in meaningful roles i.e. student,
employee, parent etc.

General Surgery/Acute Surgical Unit

The FSH general surgery service provides tertiary‐level services for planned and unplanned management of
conditions requiring surgical intervention. Examples of these surgeries include laparotomies for small bowel
obstructions, appendectomies and cholecystectomies. Ward 7A is a 24 bed ward containing a mixture of patient
presentations under the colorectal, upper GI and surgical D medical specialties. Ward 7B is a 24 bed ward
containing a mixture of patient presentations including breast surgery, gynaecological surgery, acute trauma
and acute surgical presentations. There are often multiple outlying patients who are also managed by the 7A/B
OT.

The OT role includes assessment of current functional performance on the ward and engagement in discharge
planning to facilitate independence in activities of daily living. This includes functional/ADL assessments and
retraining post‐surgery, cognitive assessments including concussion screening post trauma, pressure care and
seating assessment, provision of adaptive equipment and leading discharge planning including liaising with
other members of the MDT, providing education and organising appropriate follow up referrals.

Plastics
Plastics Hand Clinic is staffed by a mix of Physiotherapists and Occupational Therapists. It is an outpatient clinic
that treats paediatric hand injuries as well as acute adult hand injuries. Conditions that are commonly treated
include fractures, ligament injuries, tendon injuries and repairs, and scar management. Our role in the team also
includes assessing and fitting garments for compression/scar management. Our therapists are able to work
closely with treating Plastic surgeons and together plan for treatment using evidence based practice.
The OT role involves educating patients and optimising function following an injury to the upper limb. As
therapists we aim to be holistic in our treatment whilst understanding the underlying anatomy to protect
injured structures, and focus on patient goals in ongoing treatment and return to function.

FIONA STANLEY HOSPITAL OCCUPATIONAL THERAPY PLACEMENT DESCRIPTIONS |

 ‐ Education to all patients (paediatric, adults, family) regarding injuries, healing time frames and activity
modifications
‐ Fabrication of a range of splints for the upper limb
‐ Provision of exercises to improve range of motion, pain, strength and function
‐ Education and assistance with activity recommendations and assistive devices

Acute Neurology & Stroke

The acute neurology and stroke ward has 25 beds, and admits all adult patients (ages 16+) who present with
suspected neurological symptoms, or known neurological diagnoses. Some common neurological conditions
seen include stroke, Guillain‐Barre Syndrome, seizures, myositis, motor neurone disease, functional neurological
disorder, and patients admission with any unknown neurological symptoms awaiting a formal diagnosis.
Patients are admitted for medical investigations to confirm diagnosis and/or for treatment of their conditions. It
is a very fast paced ward with a patient’s normal length of stay being anywhere between a few days to a few
weeks. The occupational therapy role on the ward includes providing timely assessment, equipment
prescription (including wheelchairs), advocacy for discharge planning and rehabilitation needs, and/or
commencing rehabilitation of neurological symptoms as appropriate to the caseload. Patients admitted to the
acute ward are not always medically stable, and the OT role must be fluid and adaptable to fit around necessary
medical input and investigations.

The acute team is comprised of medical, nursing and allied health staff members including occupational
therapy, physiotherapy, speech pathology, allied health assistants, social work, dietetics and pharmacy. The
acute neurology allied health team has a strong team focus and you will be expected to work closely alongside
other members of the multi‐disciplinary team during your placement.

Acute Medical Unit (AMU)

AMU (Acute Medical Unit) is a 50 bed unit that admits patients presenting with a medical complaint with
multiple co‐morbidities and require ongoing medical management within a tertiary setting. The ward is staffed
with medical nursing and allied health members, in order to provide safe patient care with early senior clinician
review, nursing and allied health assessment, priority access to diagnostics, sub‐specialty input and
treatment. The intended length of stay for patients is < 48 hours with majority of patients being transferred or
discharged within 24 hours. Patients are aged over 18, and common medical conditions include Congestive
Cardiac Failure, Chronic Obstructive Pulmonary Disease, Transient Ischaemic Attack, Cerebral Vascular Accident,
Dementia (Alzheimer’s, Lewy body, Vascular), Syncope, Delirium, Pneumonia, Pleural Effusion, Urinary Tract
Infection, Gastro Intestinal Bleed, Falls, NSTEMI and Encephalopathy.

AMU is staffed under a Transprofessional model of practice (TPP) is skill sharing across professions rather than
“ownership” of skills according to profession. The OT role on AMU will include completing initial assessments to
gain information on social history, pre admission function and home environment; completing functional &
basic mobility assessments; completing cognitive screens and assessments; providing adaptive equipment for
discharge and referring patients to outpatient services to continue to optimise function & safety in the home
environment.

Orthopaedics and Paediatrics

The Orthopaedics & Paediatric OT caseload aims to optimise occupational performance and engagement of
patients with orthopaedic conditions; to promote sufficient patient flow and effective discharges from hospital.
The role targets OT core business (function, falls, hand therapy, pressure care and cognition) and involves
collaborating effectively with the wider multidisciplinary team. This fast‐paced caseload also includes elective
neurosurgeries, short stay and day surgery orthopaedic cases and on a referral basis, treats paediatric and
maternity patients. It involves complex discharge planning including functional retraining, referrals to external
agencies, environmental adaption/equipment provision and close liaison with the hand therapy and home
visiting speciality services.

FIONA STANLEY HOSPITAL OCCUPATIONAL THERAPY PLACEMENT DESCRIPTIONS |

The Orthopaedic home ward on 4A consists of 24 beds. Patient ages and complexity range dramatically, with a
portion falling under the Ortho‐geriatric team. Patients admit for a wide range of conditions (often traumatic in
nature), including neck of femur and lower limb fractures, upper limb fractures/ conditions, elective spinal
surgeries etc. This clinical area develops fundamental clinical and non‐clinical skill sets and is ideal for
development of prioritisation, time management, team work and fast‐paced clinical reasoning skills ‐ which is
applicable across all avenues of work as an OT.

Burns
The Burns Service at Fiona Stanley Hospital is the state‐wide service for all adult burns in WA. This encompasses
minor and major life‐threatening burns and everything in between, so our service covers ICU, inpatients,
outpatient clinics, rehabilitation and reconstruction. Inpatient care is provided through the Burns Unit which is
Ward 4B which has specific infection control procedures to minimise the risk of infection. The Burns Unit also
has one room that was purpose‐built as a Functional Training Unit to prepare patients with bigger or more
challenging burns for their return home. The unit is staffed by 3 OT positions who cover the inpatient ward,
booked outpatient therapy, and the outpatient dressings, acute and multi‐disciplinary clinics.
The OT Role in the Burns Service has two key components:
1. Function
2. Scar Management
Function covers the spectrum from basic self‐care skills through to return to independent living and return to
work. Scar management is a specialised skill and includes the prescription of pressure garments, hand therapy,
functional retraining, manual scar manipulation, specialised facial scar management, splinting and the use of a
range of contact media.

OUTPATIENT SERVICES
Home Visiting
The Home Visiting Occupational Therapy service at Fiona Stanley Hospital is a varied role, covering a wide
variety of clients with numerous injuries and functional difficulties. The service provides home assessments for
clients from all areas of the hospital, including emergency, acute medical, orthopaedics, state rehab service,
and cancer centre to name a few. OT assessments can be completed either pre or post discharge from
hospital, depending on the purpose of the visit and the client’s presenting functional difficulties. The aim of
pre‐discharge (inpatient) home visits is to ascertain whether and how the patient will be able to function and
manage in their own environment, taking into account features of the home environment, a person’s habits
and personal characteristics, as well as the demands of the task. We use the information provided to us about
a client’s expected function to make recommendations about minimum requirements for discharge home.
Post‐discharge (outpatient) visits allow us the opportunity to see the patient in their own environment doing
relevant tasks and to involve the patient/caregivers more directly in problem solving. We assess how patients
perform daily activities (i.e. getting in and out of bed, on and off chairs, and in and out of the shower) through
direct observation as well as other means. Interventions used include trial or loan of basic and essential
equipment as required to facilitate participation in ADL’s, prescription of rails and ramps to optimise safe
functional performance, and organising home modifications to enable access to essential areas of the home.
We are also involved in providing relevant education within the home, for example, functional transfer
retraining, falls prevention and pressure management education.

STATE REHABILITATION SERVICES

Acquired Brain Injury (Ward B)

There are 29 beds and the ward is divided into a 9 bed unsecured section and a 20 bed secured section requiring
swipe card access. Referrals are received from SCGH neurosurgery, RPH neurosurgery, FSH acute hospital,
Brightwater/Nursing home and regional hospitals. Patients are either under 65 years of age or were previously
high functioning in the community. Common mechanisms of injury include trauma (motor vehicle / motorbike
accidents, assaults, and falls), sub‐arachnoid haemorrhage (ruptured aneurysm or AVM), hypoxic brain injury,
encephalitis/meningitis and tumour resection.

FIONA STANLEY HOSPITAL OCCUPATIONAL THERAPY PLACEMENT DESCRIPTIONS |

The OT role is to optimise occupational engagement and performance of patients following an ABI, with a
particular focus on the impact that cognitive and upper limb impairments have on the ability to live
independently in the community. The role is very holistic and involves many different facets including:
Occupational tasks/roles: Self‐care, domestic skills, community access, managing daily routine. Performance
Components: Cognition, sensation, perception, motor (particular focus on upper limbs), vision and behaviour.
Environmental Adaptation: Aids and equipment, home visiting.

Neurology (Ward A)
The neurology rehabilitation ward is a 26 bed ward for patients generally under 65 years old, or who had a high
baseline level of functioning prior to admission, who have had a neurological condition and require inpatient
rehabilitation before being able to return home. Referrals are received from any acute hospital in Western
Australia, as well as some referrals directly from the community. The most common neurological conditions
include stroke, Guillain Barre Syndrome and Multiple Sclerosis, but can include many other types of neurological
conditions. The rehabilitation team is comprised of medical, nursing and allied health staff members including
occupational therapy, physiotherapy, speech pathology, allied health assistants, social work, clinical psychology,
dietetics and pharmacy.

The occupational therapy role on the ward is intensive and includes daily specialised neurological occupational
therapy rehabilitation with the patients, equipment prescription including complex wheelchair seating and
positioning, involvement in patient and team meetings, completion of patient related applications including the
NDIS as well as discharge planning.

Spinal (Ward 1A)

The State Spinal Unit is based on Ward 1A at Fiona Stanley Hospital. This unit provides services to spinal cord
injured patients from all around the state, who are referred to FSH for rehabilitation. The ward takes 32
inpatients, both initial injuries and readmissions. State wide Spinal services also include outpatient and outreach
services both based at FSH.

The OT Role on the Spinal Unit focuses on both the development and relearning of skills as well as the
implementation of compensatory strategies to assist patients to adapt to their new levels of ability.
This may include a focus on:
• Functional mobility – sitting balance, transfers, propulsion, bed mobility, upper limb function
• Self‐Care ‐ dressing, bathing, grooming, eating, toileting
• Domestic ‐ Meal prep, laundry etc.
• Equipment ‐ trial/selection and loan for discharge
• Environment – reviewing home set‐up, modifications etc. with Home Visiting staff, environmental
controls, IT options
• Community Access – driving advice, accessing public transport, shopping, ATM’s, restaurants etc.
• Leisure – participation in recreation programme
• Work ‐ examining further education, vocational options

Multi‐trauma (Ward 2A)

Ward 2A has 26 beds which are usually equally divided between the 2 specialities. Referrals to the multi‐trauma
rehabilitation service are mostly received from RPH‐ State Trauma Unit (STU), or orthopaedic units.
Trauma patients can be very complex. They typically have multiple orthopaedic injuries and may also have mild
brain injuries and plastic injuries eg. degloving/burns. Mechanisms of injuries include high speed motor vehicle
accidents, fall from height and deliberate self‐harm. Patients may come to us with 3‐4 limbs out of action and
progress to walking on discharge.

FIONA STANLEY HOSPITAL OCCUPATIONAL THERAPY PLACEMENT DESCRIPTIONS |

Occupational therapy involvement includes progressing their independence in self‐care activities as their injuries
resolve and to ensure a safe discharge. Occupational therapy students have exposure to wheelchair and
equipment provision, adapting home environments, a range of cognitive tests and self‐care retraining.
Multi Diagnostics patients can have a range of conditions – eg post lung transplant, respiratory distress resulting
in ICU admission. They are typically deconditioned and therapy involves engaging them in normal everyday
activities to improve their stamina and ready them for discharge. This includes self‐care retraining, continually
evaluating equipment to facilitate their progress and equipment provision for home.

Amputee Rehabilitation (Ward 2A)

Ward SRS 2A consists of 26 beds which is usually equally divided between the 2 specialties. Referrals to the
amputee rehab service come from various public and private hospitals around Perth, however patients may live
anywhere within WA.

Amputee patients can be very complex. Approximately 80% of lower limb amputees are secondary to
complications from peripheral vascular disease (related to diabetes, smoking, arthritis/autoimmune disease,
venous insufficiency). Approximately 5‐10% of amputations are traumatic (road accidents, motorbike accidents,
work place injuries, burns), and the other percentage of amputations may be from medical complications such
as malignancy, chronic infection, and sepsis (e.g.‐ meningococcal septicaemia). Majority of the amputees that
undergo inpatient rehab are lower limb amputees, or multiple limb amputees.

The OT role on the amputee unit is to optimise the occupational performance of patients following their
amputation and assist them with the adjustment to their new altered physical condition.
This includes wheelchair measurement and prescription, pressure care education, falls prevention education
and management, oedema management and graded motor imagery techniques to assist with phantom limb
pain. The OT also educates patients on pre‐prosthetic functional mobility and wheelchair skills, self‐care re‐
training, equipment prescription and home environment modifications for accessibility.

FIONA STANLEY HOSPITAL OCCUPATIONAL THERAPY PLACEMENT DESCRIPTIONS |