Critical care outreach physiotherapy response to deteriorating patients on acute hospital wards: An observational...

Critical care outreach teams provide early intervention in response to clinical deterioration on hospital wards to improve patient safety and reduce serious adverse events. A critical care outreach physiotherapy (CCOPT) service was developed to provide early physiotherapy intervention for patients identified at risk of respiratory deterioration.

The aim of this study was to describe the clinical service provided by the CCOPT, determine its feasibility and sustainability, explore patient characteristics, and report interventions provided and outcomes of the population referred.

Single-centre, retrospective, observational cohort study was conducted including patients referred to the CCOPT service between July 2019 and December 2023. Demographics, referral characteristics, physiotherapy interventions, and patient outcomes including hospital length of stay, discharge destination, and in-hospital mortality were collected.

There were 209 patients referred (median [interquartile range] age: 73 [65, 84] years, 66% male), predominantly admitted with trauma (n = 74, 35%). The most common reason for referral was increasing oxygen requirements (n = 91, 44%). Referred patients, triaged as urgent, were reviewed within a median of 30 [13, 45] minutes. Physiotherapy interventions were commenced in 86 (41%) patients, most commonly involving airway clearance techniques (n = 34, 40%) and initiation of intermittent continuous positive airway pressure (n = 30, 35%). Subsequent admission to intensive care occurred in 14% (n = 29) of cases. Hospital length of stay was a median [interquartile range] of 15 [9, 28] days, and 46% (n = 97) of patients were discharged to their prior place of residence. In-hospital mortality of the cohort referred to CCOPT was 27% (n = 57).

Physiotherapy is an emerging component of the critical care outreach team. The CCOPT service provided rapid responses to at-risk patients with respiratory deterioration in a ward environment of whom few were admitted to the ICU.