Nursing and medical staff perceptions of on-call respiratory physiotherapy

Purpose

On-call respiratory physiotherapists have sufficient experience and knowledge of treating patients to understand their own scope of practice. However, physiotherapists usually rely on the knowledge of their referring nursing and medical colleagues, with regards to the field of respiratory physiotherapy, to ensure that referrals are appropriate.

According to local data, in 2017-18 28% of call-outs were deemed ´inappropriate´, suggesting the role of the on-call physiotherapist may be a misunderstood amongst some referring staff members. To explore this, a service evaluation was undertaken with the aim of understanding the perceptions and expectations of on-call physiotherapy from nurses and doctors making referrals.

In respect of vignette one, 11 participants (58%)
answered that they would refer the patient to on-call physiotherapy in the early stages of admission.
As the patient deteriorated, fewer participants (n=8)
felt that on-call physiotherapy would be appropriate and instead considered referring the patient for further ventilatory support.

Approach

A two-part survey was developed. Part one consisted of two vignettes with accompanying questions. The first vignette described a patient with retained secretions and shortness of breath, amenable to physiotherapy. The second described a patient with signs and symptoms of pulmonary oedema, not considered appropriate for on-call physiotherapy. The vignettes unfolded in several stages, and respondents were asked questions regarding the utility of on-call respiratory physiotherapy as the cases developed. In part two, respondents were questioned more generally about their perceptions of on-call physiotherapy. The survey was created, piloted and circulated via SurveyMonkey®. Nurses and doctors working in areas referring to on-call physiotherapy were invited to participate. Snowball sampling was encouraged.

Outcomes

Seven nurses and 12 doctors completed the survey. Participants´ seniority ranged from newly qualified to consultant level, and all except one had previously referred to on-call physiotherapy.

In respect of vignette one, 11 participants (58%) answered that they would refer the patient to on-call physiotherapy in the early stages of admission. As the patient deteriorated, fewer participants (n=8) felt that on-call physiotherapy would be appropriate and instead considered referring the patient for further ventilatory support. Regarding the second vignette, all participants recognised that on-call physiotherapy would be unlikely to provide benefit to the patient.

Results from section two suggested that participants had a positive perception of on-call physiotherapy; 95% (n=18) strongly agreed/agreed that physiotherapists were a valuable part of the multidisciplinary team, were team players and good communicators; 84% (n=16) strongly agreed/agreed that on-call physiotherapists were able to see things from a different angle. Participants also felt that on-call physiotherapists could (very likely/likely) contribute to discussions about non-invasive ventilation, oxygen and devices, medications/nebulisers and treatment escalation (89%, 79%, 74% and 68%, respectively).

Implications

Referrers to on-call physiotherapy had a positive perception of on-call physiotherapy. They could correctly identify on-call situations not amenable to physiotherapy and recognised the contribution to patient management that could be offered. However, only just over half said that they would refer a patient with retained secretions to an on-call physiotherapist, suggesting that further promotion and dissemination of information regarding the remit, scope and benefits of on-call physiotherapy may be required.

This service evaluation suggests that nurses and doctors value on-call physiotherapy. The study is limited by the small number of respondents and associated risks of self-selection bias. Gaps highlighted by the vignettes could inform further training for referrers, particularly concerning patients presenting with complex clinical pictures.

Funding acknowledgements

This project was undertaken as part of an MSc in advanced cardiorespiratory physiotherapy at UCL. No additional funding was required for the service evaluation

Additional notes

This work was presented at Physiotherapy UK 2019