Vegh Leah A, Blunt Alison M, Wishart Laurelie R, Gane Elise M, Paratz Jennifer D
Department of Physiotherapy, Princess Alexandra Hospital, Brisbane, Australia.
Department of Physiotherapy, Princess Alexandra Hospital, Brisbane, Australia.
Aust Crit Care. 2023 Mar;36(2):223-231. doi: 10.1016/j.aucc.2022.01.005. Epub 2022 Mar 24.
Critical care outreach teams support ward staff to manage patients who are seriously ill or after discharge from the intensive care unit (ICU). Respiratory deterioration is a common reason for (re)admission to the ICU. Physiotherapists are health professionals with skills to address acute respiratory concerns. Experienced respiratory physiotherapists play a role in supporting junior clinicians, particularly in managing deteriorating patients on the ward.
The objective of this study was to evaluate a novel respiratory physiotherapy critical care outreach-style service. The primary objective was to describe service referrals and the patient cohort. Other objectives were to compare the effects of this model of care on ICU readmission rates to a historical cohort and explore clinician perceptions of the model of care and its implementation.
A new physiotherapy model of care worked alongside an existing nurse-led outreach service to support physiotherapists with the identification and management of patients at risk of respiratory deterioration or ICU (re)admission. Purpose-built and pre-existing databases were used for prospective data collection and for a historical ICU readmissions control group. Questionnaires and semistructured group interviews were utilised to evaluate clinician satisfaction and perceptions.
The service accepted referrals for 274 patients in 6 months (on average 2.25/working day; commonly after trauma [29%] and abdominal surgery [19%]). During the implementation period of the model of care, fewer preventable respiratory ICU readmissions were reported (n = 1/20) than in the historical cohort (n = 6/19: Fisher's exact test, p < 0.05). Likelihood of respiratory ICU readmission, compared to all-cause readmissions, was not affected (intervention: 31%, historical control: 41%; odds ratio: 0.63 [95% confidence interval: 0.29 to 1.4]). Postimplementation surveys and focus groups revealed clinicians highly valued the support and perceived a positive impact on patient care.
Critical care outreach-style physiotherapy services can be successfully implemented and are positively perceived by clinicians, but any effect on ICU readmissions is unclear.
重症监护外展团队协助病房工作人员管理重症患者或重症监护病房（ICU）出院后的患者。呼吸功能恶化是患者再次入住ICU的常见原因。物理治疗师是具备处理急性呼吸问题技能的医疗专业人员。经验丰富的呼吸物理治疗师在支持初级临床医生方面发挥着作用，尤其是在管理病房中病情恶化的患者时。
本研究的目的是评估一种新型的呼吸物理治疗重症监护外展式服务。主要目的是描述服务转诊情况和患者队列。其他目的是将这种护理模式对ICU再入院率的影响与一个历史队列进行比较，并探讨临床医生对该护理模式及其实施的看法。
一种新的物理治疗护理模式与现有的由护士主导的外展服务并行开展，以协助物理治疗师识别和管理有呼吸功能恶化风险或有再次入住ICU风险的患者。使用专门构建的数据库和现有的数据库进行前瞻性数据收集，并设立一个历史ICU再入院对照组。通过问卷调查和半结构化小组访谈来评估临床医生的满意度和看法。
该服务在6个月内接受了274例患者的转诊（平均每天2.25例；常见于创伤后[29%]和腹部手术后[19%]）。在护理模式的实施期间，报告的可预防的呼吸相关ICU再入院病例数（n = 1/20）少于历史队列（n = 6/19：Fisher精确检验，p < 0.05）。与所有原因导致的再入院相比，呼吸相关ICU再入院的可能性未受影响（干预组：31%，历史对照组：41%；比值比：0.63 [95%置信区间：0.29至1.4]）。实施后的调查和焦点小组显示，临床医生高度重视这种支持，并认为对患者护理有积极影响。
重症监护外展式物理治疗服务可以成功实施，并且临床医生对其评价积极，但对ICU再入院率的任何影响尚不清楚。
