Evolution of physiotherapist staffing and workload in Chilean intensive care units during the COVID-19 pandemic.

To describe and analyze changes in ICU physiotherapy staff and their workload during the first year of the COVID-19 pandemic.

We selected the answers related to staffing and workload of a nationwide cross-sectional study. One representative physiotherapist (PT) from each ICU in Chile (n=130) was surveyed at four time points: March 2020 (retrospective pre-pandemic [P1]), July 2020 (P2), October 2020 (P3), and March 2021 (P4). Variables assessed included ICU bed capacity, PT staffing levels, workload ratios, staffing contracts, and bed expansion strategies. Descriptive statistics were reported using medians [IQR] and frequencies (%). Statistical significance was set at p0.05.

Of the 111 ICUs agreeing to participate, 84 (76% response rate) completed all surveys. Forty-seven (42%) were in the Metropolitan region and 48 (57%) were public institutions. ICU beds increased from a median of 10 [6–15] in P1 to 30 [12–44] in P2 (p0.001), decreased to 15 [11–27] in P3 increasing again to 24 [14–54] in P4. PT staffing increased accordingly, with median PTs per ICU increasing from 2 [1–3] to 5 [2–8] during daytime weekdays and from 1 [0–1] to 3 [1–6] during night-time in P2 (p0.001), remaining without changes thereafter. Twenty-four/seven PT coverage increased from 53 (64%) in P1 to 74 (88%) from P2 onwards (p0.001). The ICU bed-to-PT ratio during daytime decreased from 7 [6-8] to 6 [6-8] (p=0.24) and night-time from 8 [4-12] to 7 [6-9] (p=0.97). Institutional PT contracts decreased from 67 (80%) in P1 to 50 (60%) in P2, recovering to 66 (79%) by P4 (p=0.004), while casual contracts initially increased from 25 (30%) in P1 to 57 (68%) in P2, then decreased to 53 (63%) in P4 (p0.001). Hiring new PTs occurred in 69 (82%) of ICUs in P2, significantly decreasing to 24 (29%) in P3 and just 1% in P4 (p0.001). Meeting the recommended bed-to-PT ratio (6:1) was consistently the top staffing priority, followed by replacing PTs due to sick leave, while addressing burnout and replacing at-risk PTs were lower priorities. 

The COVID-19 pandemic led to significant increases in ICU bed capacity and PT workforce in Chilean ICUs. Early in the pandemic, the increased PT number and the establishment of 24/7 coverage were crucial to managing patient care demands. This synchronization between ICU bed capacity and PT staffing provides a valuable framework for future healthcare crisis preparedness. These findings emphasize the importance of flexible and scalable staffing strategies that align physiotherapist availability with ICU demands.

This study highlights the critical role of PTs in Chilean ICUs during health emergencies. Future preparedness plans should incorporate adaptable staffing models to ensure adequate ICU physiotherapist coverage in similar crises.