PHYSIOTHERAPISTS IN CHILEAN ADULT INTENSIVE CARE UNITS: WHAT DO WE HAVE?

Aranis N.^1,2, Pinto-Concha J.J.¹, Leppe J.¹, Molina J.¹, Castro-Avila A.^1,3, Fu C.⁴, Merino-Osorio C.¹

¹Universidad del Desarrollo, School of Physical Therapy, Santiago, Chile, ²Clínica Alemana de Santiago, Physical Therapy and Rehabilitation, Santiago, Chile, ³University of York, Department of Health Sciences, York, United Kingdom, ⁴Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil

Background: International and Chilean intensive care medicine societies have recommended that specialized physiotherapists should be present 24 hours/7 days a week (24/7) in the Intensive Care Unit (ICU). However, adherence to these recommendations is unknown. In Chile, the National Health Service (NHS) aims to increase in 44% the allocation of clinical staff in ICUs by 2020. Knowledge about the actual Chilean coverage of physiotherapists in ICUs may encourage informed decision-making for accomplishment of national health-related goals.

Purpose: Efficient use of economic resources in health settings requires a baseline knowledge of national actual situation. The aims of this study are:
(1) to determine the gap of coverage of 24/7 physiotherapists in Chilean Adult ICU departments, and
(2) to describe the administrative characteristics of NHS ICUs and their physiotherapists.

Methods: A cross-sectional study was conducted. A telephone-based survey was used to collect data from physiotherapists of the Chilean NHS ICUs. Respondents were required to report information about the administrative (number of beds, ICU level of complexity according to the NHS, administrative dependency) and physiotherapy staff (number of sessions per patient and physiotherapists per shift, contractual system, working hours and professional training level) characteristics of their ICUs. The STATA 13.0 software was used for statistical analysis.

Results: Nineteen Adult ICU departments were included in this study. The total coverage gap of 24/7 physiotherapists in Chilean NHS ICUs was 21%. It was found a median (P75-P25) of 11 (16-6) number of beds per ICU. A ¨high level of complexity¨ was reported in 79% (n=15) of all ICUs. Physiotherapists from 63% of all ICUs are administratively dependent of the Physical Therapy and Rehabilitation Department. Respondents reported that the highest number of physiotherapy sessions were performed in the daylight-time shift during weekdays with a median (P75-P25) of 2 (3-2) per patient and a mean of 2 (min1-max6) physiotherapists per shift. A mean of 5 (min0-max12) currently hired physiotherapists per unit were reported. The predominating shift model of working hours was “12 hours on daylight-time for day 1, 12 hours on night-time for day 2, and off work during days 3 and 4”; covering 24 hours/7 days a week in 79% of all ICUs. Seven (7) out of a total of 132 physiotherapists (5.3%) were reported as specialists in intensive care physiotherapy.

Conclusion(s): Although a high number of the Chilean NHS ICUs reported to have full 24/7 physiotherapists coverage, there is still a proportion of ICUs that does not meet the international standard criteria. A very low proportion of physiotherapists reached the level of professional training recommended to practice in ICUs. Future studies should focus on identify barriers to non-achievement of such international recommendations.

Implications: National scientific societies should consider these findings to generate the strategies that may facilitate the incorporation of 24/7 physiotherapists in all Chilean Adult ICUs. This information should be use by the National Health Service to make decisions on the type of clinical professional to be incorporated in the ICUs.

Funding acknowledgements: None.

Topic: Professional issues

Ethics approval: Approved by the Ethics Research Committee of the Faculty of Medicine at the Universidad del Desarrollo-Clínica Alemana, Chile.

All authors, affiliations and abstracts have been published as submitted.