A seven-day physiotherapy service

The role of speech-language pathology weekend service in inpatient subacute care: A national survey

PURPOSE

Limited evidence is available on speech-language pathology (SLP) weekend services within the subacute inpatient setting. This study aimed to describe Australian SLP weekend services for stroke adult inpatients in subacute units and to explore clinicians' perspectives on factors that influence the delivery of the service.

METHOD

Speech-language pathologists who worked in Australian subacute hospital-based units participated in an online cross-sectional survey. Descriptive statistics and content analysis were undertaken to analyse quantitative and qualitative data.

RESULT

From the total of 83 participating clinicians, 20 (24%) worked in rehabilitation units that provided an SLP weekend service. Assessments and reviews were the main clinical activities provided to stroke inpatients by this service. Workforce and evidence were commonly cited as facilitators and barriers to both the implementation of a new service and the continuation of an existing service. The "ideal" SLP weekend subacute service to stroke inpatients was typically described as a combination of assessment, therapy, education and training.

CONCLUSION

Findings from this study's sample indicate that an SLP weekend inpatient rehabilitation service to stroke inpatients was not standard practice. Different perspectives regarding the purpose and need of an SLP weekend service were reported.

After-hours respiratory physiotherapy for intubated and mechanically ventilated patients with community-acquired pneumonia: An Australian perspective

INTRODUCTION

Community acquired pneumonia (CAP) is a common reason for admission to an intensive care unit for intubation and mechanical ventilation, and results in high morbidity and mortality. The primary aim of the study was to investigate availability and provision of respiratory physiotherapy, outside of normal business hours, for intubated and mechanically ventilated adults with CAP in Australian hospitals.

MATERIALS AND METHODS

A cross-sectional, mixed methods online survey was conducted. Participants were senior intensive care unit physiotherapists from 88 public and private hospitals. Main outcome measures included presence and nature of an after-hours physiotherapy service and factors perceived to influence the need for after-hours respiratory physiotherapy intervention, when the service was available, for intubated adult patients with CAP. Data were also collected regarding respiratory intervention provided after-hours by other ICU professionals.

RESULTS

Response rate was 72% (n=75). An after-hours physiotherapy service was provided by n=31 (46%) hospitals and onsite after-hours physiotherapy presence was limited (22%), with a combination of onsite and on-call service reported by 19%. Treatment response (83%) was the most frequent factor for referring patients with CAP for after-hours physiotherapy intervention by the treating day-time physiotherapist. Nurses performing respiratory intervention (77%) was significantly associated with no available after-hours physiotherapy service (p=0.04).

DISCUSSION

Physiotherapy after-hours service in Australia is limited, therefore it is common for intubated patients with CAP not to receive any respiratory physiotherapy intervention outside of normal business hours. In the absence of an after-hours physiotherapist, nurses were most likely to perform after-hours respiratory intervention to intubated patients with CAP.

CONCLUSION

Further research is required to determine whether the frequency of respiratory physiotherapy intervention, including after-hours provision of treatment, influences outcomes for ICU patients intubated with pneumonia.

Cardiorespiratory Physiotherapy around the Clock: Experience at a University Hospital

Purpose: To document and describe the use of a hospital-wide, 24-hour cardiorespiratory physiotherapy service run by an intensive care unit (ICU) team of physiotherapists. Methods: We prospectively collected data on all non-ICU hospital patients who used the 24-hours-per-day cardiorespiratory physiotherapy service over a 1-year period between July 2013 and June 2014. The ICU physiotherapists documented the reason, origin of referral, time of call, and type and frequency of treatment of each patient. Results: Over the 1-year period, the ICU physiotherapists administered 2,192 out-of-hours cardiorespiratory physiotherapy treatments (n=685 patients) outside the ICU. Most referrals originated from the emergency department (25%), the cardiopulmonary transplant unit (20%), and the pulmonology department (16%). Referrals were from a physiotherapist in 49% of cases, from a nurse in 32%, and from a physician in 19%. Of these, 89% were made between 4:00 p.m. and 8:00 a.m., and sputum retention was the most frequent reason (86%). Conclusion: Although proving its cost effectiveness is difficult, organizing a 24-hours-per-day, 7-days-per-week cardiorespiratory physiotherapy service in a large hospital is feasible.