Introduction of a Physiotherapy Associate Practitioner role on Critical Care: an innovative service improvement to enhance seven-day services and improve efficiency and quality of care

Introduction: Rehabilitation after Critical Illness (RaCI) and Enhanced Recovery after Surgery (ERAS) have been areas of increasing focus over the last decade. Physiotherapy is integral to the optimal delivery of both pathways. Historically, physiotherapy staffing on our ICU limited the ability to best deliver these services.

To address this, we developed a non-qualified Physiotherapy Associate Practitioner (PAP) role within ICU to carry a caseload of elective surgical patients. This increased the mobilisation of ERAS patients, and also released a specialist critical care physiotherapist to coordinate a multi-disciplinary RaCI service.

Aims:

• Improve outcomes for surgical patients.

• More therapeutic time to patients with complex needs.

• More consistent physiotherapy service on the ICU, seven days a week.

• A multidisciplinary team (MDT) RaCI service; weekly outreach rounds and monthly outpatient clinic.

Method: 1.8 WTE Band 4 PAPs were recruited on a pilot basis. They both completed a comprehensive training and competency framework. Functional mobility outcome scores at discharge from ICU and weekend productivity statistics were collected for six months. This was compared with data from 6 months prior to the pilot commencing. The senior physiotherapist co-ordinated the RACI pathway, as per NICE CG83. This included involvement in each RaCI patient’s rehabilitation on ITU, ward follow up, and outpatient review. Data was also collected to evaluate RaCI Pathway delivery.

Results:
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Conclusion: We have described an innovative service change within the ICU physiotherapy team. This has allowed implementation of an enhanced mobility service 7 days a week. It has also facilitated the development of a RaCI service, to address the complex needs of long-term ICU patients. The recruitment of PAPs represents a relatively small financial investment, but one that has facilitated a restructure of the physiotherapy team, allowing optimisation of resource allocation to different ICU patient groups. Given the current financial constraints on NHS services, this project represents a unique and practical approach to achieving NHS England’s recommendation for safe, sustainable staffing with “the right staff, with the right skills, in the right place, at the right time” (National Quality Board 2016).