Physiotherapy at night: A multicentre prospective audit of respiratory-based physiotherapy services provided at night in Queensland

INTRODUCTION: Hospitals may provide access to respiratory-based physiotherapy services at night. Little is known about the patient case-mix, treatments provided, or how different physiotherapy service models compare. OBJECTIVE: The aim of this study was to describe and compare respiratory-based physiotherapy services provided at night, including patient characteristics, ward locations, treatments provided, and service characteristics including frequency of use, staffing, resource requirements, and fatigue leave. METHODS: A prospective audit of respiratory-based physiotherapy services at night was conducted between March and September 2021 across 11 Queensland hospitals. Data were collected on patient and staff characteristics, ward location, type and frequency of treatment provided, service model, resources required, and the frequency of fatigue leave. RESULTS: Hospitals varied in size with bed numbers ranging from 235 to 1000 (mean 570, standard deviation [SD]: 245) and location [metropolitan 73%, regional 27%]). All sites provided overnight on-call services, and two provided evening shifts. Over the 6-month period, 1159 patients (478 on call, 681 evening) received 2558 occasions of service. Patients most often had a natural airway (76%), and during on-call shifts, patients were more often located outside of intensive care units (59%). While multiple treatment modalities were often provided in a physiotherapy session, percussion or vibrations to the chest wall was the most frequent treatment provided on-call (76%) and patient education (58%) during evening shifts. Use of on-call services across all sites ranged from 1% to 93% of nights, and fatigue leave triggered from 1% to 30% of nights across the 11 sites. Services were often provided by junior physiotherapists with less than 5 years' experience (49% on call, 65% evening shift). CONCLUSIONS: Respiratory-based physiotherapy services provided at night varied greatly across hospitals. On-call and evening-shift physiotherapists delivered multimodal treatments mostly to patients with a natural airway, located in the intensive care unit or hospital wards.