Specialist physios needed on respiratory support units seven days a week, national guidance stresses
Every respiratory support unit (RSU) in the UK should employ specialist physiotherapists on a seven-days-a-week basis, according to guidance published today by the British Thoracic Society (BTS) and the Intensive Care Society (ICS).
The guidance – titled Respiratory Support Units: Guidance on development and implementation – says physiotherapists are ‘essential members’ of the multidisciplinary teams (MDTs) that treat patients during three stages: acute admission, rehabilitation and discharge.
The guidance avoids setting physiotherapy staffing ratios, saying these will vary according to how acute the patients’ needs are in a particular RSU. But it emphasises that such units require more intensive physiotherapy staffing levels than other respiratory and medical wards.
‘Flexible models should exist to meet the demand on workforce and available resource and may include extended days, twilight shifts, night shifts and seven-day working where appropriate.'
Rosters should be established to ensure that on-call physiotherapists are available out of hours and, and that any incidents of staff sickness can be covered.
Covid-19 pandemic response
The ICS and BTS collaborated on producing the guidance after the Covid-19 epidemic triggered ‘significant increases’ in the demand for respiratory and critical care services – and in the use of equipment such as continuous positive airway pressure (CPAP) and high flow nasal oxygen (HFNO).
Stressing that ‘daily physiotherapy input is essential’ in RSUs, the guidance says physios with expertise in CPAP, HFNO, non-invasive ventilation (NIV) and rehabilitation should act as service leads, working alongside the unit’s lead consultant and senior nurse.
Banding and training issues
Any redeployment of physiotherapists into the RSU during surges of Covid-19 or other epidemic infections should include careful consideration of competencies and skill sets and the impact on existing services [BTS/ICS guidance]
Physiotherapists, who should be employed at band 7 or above, must be experienced in managing patients with complex ventilation needs and should be able to train and support MDT colleagues, the guidance notes.
‘The initiation of CPAP, HFNO, NIV and airway clearance/MI-E [mechanical insufflation-exsufflation] should only be carried out by a physiotherapist with relevant training and may be dependent on individual trusts’ local policies.’
Funding should be made available to ensure that physiotherapists have the skills required to work in RSUs, and training courses should be offered on a ‘protected time’ basis.
‘Any redeployment of physiotherapists into the RSU during surges of Covid-19 or other epidemic infections should include careful consideration of competencies and skill sets and the impact on existing services.’
Getting it Right First Time
The guidance refers to an NHS Getting it Right First Time (GIRFT) report finding that those hospitals which developed RSU-like services in response to the pandemic reported lower levels of mortality compared to their counterparts that did not.
In the light of their success in dealing with complex respiratory conditions, GIRFT has recommended that RSUs should be established as a standard service across the NHS, the guidance states.
Key figures voice support for RSUs
One of the report’s authors, Ben Messer, a consultant in critical care and home ventilation, said: ‘The document provides guidance to inform planning and business cases for the development of RSUs as well as acknowledging and strengthening the key link between critical care medicine and respiratory medicine.’
Andrew Menzies-Gow, national clinical director for respiratory disease at NHS England and NHS Improvement, said: ‘During the pandemic, respiratory teams have helped to manage the majority of acute Covid-19 patients.' The RSUs worked closely with intensive care teams to ensure patients receive optimal care in the correct environment, he noted.
Professor Menzies-Gow added: ‘This integrated way of working has proven effective and is an example of how the approaches established over the past year will have an ongoing benefit for patients.’
Jon Bennett, BTS chair, said: ‘Respiratory support units have been, and will continue to be an essential tool in the response to COVID-19, but their scope is much broader and their applications more numerous.'
Professor Bennett added: ‘If widely established and properly resourced, as we recommend, they will also bring real improvement to the way we manage patients admitted to hospital with acute respiratory illnesses, especially during the winter surges (“winter pressures”).’
What does an RSU do? (summary of report points)
• provides a safe and effective environment to manage patients with complex respiratory disease or patients at risk of deterioration with acute respiratory disease
• allows patients with complex respiratory disease, or at risk of deterioration, to be located together to help concentrate multi-professional skills
• brings multi-professional skills and experience together to bridge the gap between ward level care and critical care for patients with significant respiratory disease
• facilitates the early recognition and treatment of new changes in the clinical condition of patients who are acutely unwell with respiratory disease
• facilitates robust governance processes for such patients, with the overarching aim that improved infrastructure, staffing, and monitoring may improve patient outcomes
To see Respiratory Support Units: Guidance on development and implementation, visit: https://www.brit-thoracic.org.uk/delivery-of-care/respiratory-support-units/
To the GIRFT Programme, visit: https://www.gettingitrightfirsttime.co.uk/
The BTS is a charity with more than 3,800 members – including doctors, nurses, respiratory physiotherapists, scientists and other professionals in the field.
Author: Ian A McMillan