Introducción
La Sociedad Europea de Medicina de Cuidados Intensivos recomienda la presencia de un Kinesiólogo con formación especializada, disponible cada cinco camas de alta complejidad, los 7 días de la semana en la Unidad de Cuidados Intensivos (UCI). En Chile se desconoce la adherencia de las UCI adulto a esta recomendación.

Objetivo
Describir las características administrativas y de cobertura kinésica en las UCI adulto chilenas, y de acuerdo con la adherencia a las recomendaciones internacionales, informar a los tomadores de decisión en salud.

Métodos
Estudio observacional transversal, basado en encuesta telefónica. Se incluyeron las UCI adultos de establecimientos de mayor complejidad, clínicas privadas y centros asociados a universidades (n = 74). La proporción de instituciones con disponibilidad de kinesiólogos las 24 horas del día, los siete días de la semana (kinesiólogo 24/7), con un número máximo de cinco pacientes por kinesiólogo y presencia de un kinesiólogo especialista fueron reportados.

Resultados
La tasa de respuesta fue del 86,5% (n = 64), principalmente públicas (59%) y de nivel III (83%). El 70% (n = 45) de las UCI adulto chilenas cuentan con kinesiólogo 24/7; correspondiendo el 87% al sector público y el 46% al privado. El 41% de los centros posee un máximo de 5 pacientes por kinesiólogo en día hábil diurno, disminuyendo en fines de semana y horarios nocturnos. Un 23% de las UCIs cuenta con kinesiólogo especialista en intensivo, siendo mayor en el sector privado (31%).

Conclusiones
En UCI adulto chilenas, la disponibilidad de kinesiólogos 24/7 es alta, y la prevalencia de especialistas es baja. Estrategias de creación de programas de formación de especialidad podrían contribuir a disminuir la brecha de especialistas.

Authors: Nadine Aranis[1], Jorge Molina[2], Jaime Leppe[2], Ana Cristina Castro-Ávila[2,3], Carolina Fu[4], Catalina Merino-Osorio[2]

Affiliation:
[1] Physical Medicine and Rehabilitation Service, Clínica Alemana de Santiago, Santiago, Chile
[2] School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
[3] Department of Health Sciences, University of York, Heslington, York, United Kingdom
[4] Departament of Physical Therapy, Speech and Occupational Therapy, Faculty of Medicine -Universidade São Paulo, São Paulo, Brasil

E-mail: catalinamerino@udd.cl

Author address:
[1] School of Physical Therapy
Facultad de Medicina
Clínica Alemana Universidad del Desarrollo
Las Condes
Santiago de Chile

Citation: Aranis N, Molina J, Leppe J, Castro-Ávila AC, Fu C, Merino-Osorio C. Characteristics of physiotherapy staffing levels and caseload: a cross-sectional survey of Chilean adult Intensive Care Units. Medwave 2019;19(1):e7576 doi: 10.5867/medwave.2019.01.7576

Submission date: 6/11/2018

Acceptance date: 21/1/2019

Publication date: 26/2/2019

Origin: not commissioned

Type of review: external peer review by three external, double-blind reviewers

PubMed record

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1. Gobierno de Chile, Ministerio de Salud, Subsecretaría de Redes Asistenciales M. Nivel de Complejidad en Atención Cerrada. Santiago, Chile: MINSAL; 2012.
2. Gobierno de Chile, Ministerio de Salud. Criterios clasificación según nivel de complejidad de establecimientos hospitalarios; 2013 [on line]. | Link |
3. Saez E. Guías 2004 de organización y funcionamiento de unidades de pacientes críticos. Rev Chil Med Intensiva. 2004;19(4):209-23. | Link |
4. Valentin A, Ferdinande P; ESICM Working Group on Quality Improvement. Recommendations on basic requirements for intensive care units: structural and organizational aspects. Intensive Care Med. 2011 Oct;37(10):1575-87. | CrossRef | PubMed |
5. Danbury C, Gould T, Baudouin S, Berry A, Bolton S, Borthwick M, et al. Guidelines for Provision of Intensive Care Services. Intensive Care Society; 2015. [on line]. | Link |
6. Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med. 2013 Jun;41(6):1543-54. | CrossRef | PubMed |
7. Castro AA, Calil SR, Freitas SA, Oliveira AB, Porto EF. Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients. Respir Med. 2013 Jan;107(1):68-74. | CrossRef | PubMed |
8. Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012 Mar;23(1):5-13. | PubMed |
9. Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011 Apr 7;364(14):1293-304. | CrossRef | PubMed |
10. Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003 Feb 20;348(8):683-93. | CrossRef | PubMed |
11. Calvo-Ayala E, Khan BA, Farber MO, Ely EW, Boustani MA. Interventions to improve the physical function of ICU survivors: a systematic review. Chest. 2013 Nov;144 (5):1469-1480. | CrossRef | PubMed |
12. Castro-Avila AC, Serón P, Fan E, Gaete M, Mickan S. Effect of Early Rehabilitation during Intensive Care Unit Stay on Functional Status: Systematic Review and Meta-Analysis. PLoS One. 2015 Jul 1;10(7):e0130722. | CrossRef | PubMed |
13. Skinner EH, Berney S, Warrillow S, Denehy L. Rehabilitation and exercise prescription in Australian intensive care units. Physiotherapy. 2008 Sep;94(3):220-9. | CrossRef |
14. Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008 Jul;34(7):1188-99. | CrossRef | PubMed |
15. Merino-Osorio C, Castro-Ávila AC, Arias-Gutiérrez R, Arriagada MJ, Villanueva C, Leppe J, et al. Effects of 24-hours/day versus business hours physical therapy intervention in adult intensive care unit patients: a systematic review. Int Phys Med Rehabil J. 2018;3(1):100-6. | CrossRef |
16. Haines TP, Bowles KA, Mitchell D, O'Brien L, Markham D, Plumb S, et al. Impact of disinvestment from weekend allied health services across acute medical and surgical wards: 2 stepped-wedge cluster randomised controlled trials. PLoS Med. 2017 Oct 31;14(10):e1002412. | CrossRef | PubMed |
17. Mills E, Hume V, Stiller K. Increased allied health services to general and acute medical units decreases length of stay: comparison with a historical cohort. Aust Health Rev. 2018 Jun;42(3):327-333. | CrossRef | PubMed |
18. Intensive Care Society. Core Standards for Intensive Care Units. Core Stand Intensive Care Units. 2013;1:1-27. | Link |
19. Wright SE, Thomas K, Watson G, Baker C, Bryant A, Chadwick TJ, et al. Intensive versus standard physical rehabilitation therapy in the critically ill (EPICC): a multicentre, parallel-group, randomised controlled trial. Thorax. 2018 Mar;73(3):213-221. | CrossRef | PubMed |
20. Johnson AM, Henning AN, Morris PE, Tezanos AGV, Dupont-Versteegden EE. Timing and Amount of Physical Therapy Treatment are Associated with Length of Stay in the Cardiothoracic ICU. Sci Rep. 2017 Dec 14;7(1):17591. | CrossRef | PubMed |
21. Stone SA. Staffing levels: give us a tool for optimum staffing levels. 2018. csp.org.uk [on line]. | Link |
22. Allied Health Professions the Workforce and the Services They Provide. 2017;(March). | Link |
23. Cartmill L, Comans TA, Clark MJ, Ash S, Sheppard L. Using staffing ratios for workforce planning: Evidence on nine allied health professions. Hum Resour Health. 2012;10:1-8. | Link |
24. Skinner EH, Haines KJ, Berney S, Warrillow S, Harrold M, Denehy L. Usual Care Physiotherapy During Acute Hospitalization in Subjects Admitted to the ICU: An Observational Cohort Study. Respir Care. 2015 Oct;60(10):1476-85. | CrossRef | PubMed |
25. Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med. 2014 May;42(5):1178-86. | CrossRef | PubMed |
26. Berney SC, Harrold M, Webb SA, Seppelt I, Patman S, Thomas PJ, et al. Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resusc. 2013 Dec;15(4):260-5. | PubMed |
27. Berney SC, Rose JW, Bernhardt J, Denehy L. Prospective observation of physical activity in critically ill patients who were intubated for more than 48 hours. J Crit Care. 2015 Aug;30(4):658-63. | CrossRef | PubMed |
28. Connolly BA, Mortimore JL, Douiri A, Rose JW, Hart N, Berney SC. Low Levels of Physical Activity During Critical Illness and Weaning: The Evidence-Reality Gap. J Intensive Care Med. 2017 Jan 1:885066617716377. | CrossRef | PubMed |
29. Grammatopoulou E, Charmpas TN, Strati EG, Nikolaos T, Evagelodimou A, Vlassia Belimpasaki, Skordilis EK. The scope of physiotherapy services provided in public ICUs in Greece: A pilot study. Physiother Theory Pract. 2017 Feb;33(2):138-146. | CrossRef | PubMed |
30. Norrenberg M, Vincent JL. A profile of European intensive care unit physiotherapists. European Society of Intensive Care Medicine. Intensive Care Med. 2000 Jul;26(7):988-94. | CrossRef | PubMed |
31. Campbell L, Bunston R, Colangelo S, Kim D, Nargi J, Hill K, et al. The provision of weekend physiotherapy services in tertiary-care hospitals in Canada. Physiother Can. 2010 Fall;62(4):347-54. | CrossRef | PubMed |
32. Griffiths P, Ball J, Murrells T, Jones S, Rafferty AM. Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: a cross-sectional study. BMJ Open. 2016 Feb 9;6(2):e008751. | CrossRef | PubMed |
33. National Quality Board. An improvement resource for urgent and emergency. 2017;(November). | Link |
34. Haupt MT, Bekes CE, Brilli RJ, Carl LC, Gray AW, Jastremski MS, et al. Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care. Crit Care Med. 2003 Nov;31(11):2677-83. | CrossRef | PubMed |
35. Fisher ME, Aristone MN, Young KK, Waechter LE, Landry MD, Taylor LA, et al. Physiotherapy Models of Service Delivery, Staffing, and Caseloads: A Profile of Level I Trauma Centres across Canada. Physiother Can. 2012 Fall;64(4):377-85. | CrossRef | PubMed |

Gobierno de Chile, Ministerio de Salud, Subsecretaría de Redes Asistenciales M. Nivel de Complejidad en Atención Cerrada. Santiago, Chile: MINSAL; 2012.

Gobierno de Chile, Ministerio de Salud. Criterios clasificación según nivel de complejidad de establecimientos hospitalarios; 2013 [on line]. | Link |

Saez E. Guías 2004 de organización y funcionamiento de unidades de pacientes críticos. Rev Chil Med Intensiva. 2004;19(4):209-23. | Link |

Valentin A, Ferdinande P; ESICM Working Group on Quality Improvement. Recommendations on basic requirements for intensive care units: structural and organizational aspects. Intensive Care Med. 2011 Oct;37(10):1575-87. | CrossRef | PubMed |

Danbury C, Gould T, Baudouin S, Berry A, Bolton S, Borthwick M, et al. Guidelines for Provision of Intensive Care Services. Intensive Care Society; 2015. [on line]. | Link |

Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med. 2013 Jun;41(6):1543-54. | CrossRef | PubMed |

Castro AA, Calil SR, Freitas SA, Oliveira AB, Porto EF. Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients. Respir Med. 2013 Jan;107(1):68-74. | CrossRef | PubMed |

Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012 Mar;23(1):5-13. | PubMed |

Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011 Apr 7;364(14):1293-304. | CrossRef | PubMed |

Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003 Feb 20;348(8):683-93. | CrossRef | PubMed |

Calvo-Ayala E, Khan BA, Farber MO, Ely EW, Boustani MA. Interventions to improve the physical function of ICU survivors: a systematic review. Chest. 2013 Nov;144 (5):1469-1480. | CrossRef | PubMed |

Castro-Avila AC, Serón P, Fan E, Gaete M, Mickan S. Effect of Early Rehabilitation during Intensive Care Unit Stay on Functional Status: Systematic Review and Meta-Analysis. PLoS One. 2015 Jul 1;10(7):e0130722. | CrossRef | PubMed |

Skinner EH, Berney S, Warrillow S, Denehy L. Rehabilitation and exercise prescription in Australian intensive care units. Physiotherapy. 2008 Sep;94(3):220-9. | CrossRef |

Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008 Jul;34(7):1188-99. | CrossRef | PubMed |

Merino-Osorio C, Castro-Ávila AC, Arias-Gutiérrez R, Arriagada MJ, Villanueva C, Leppe J, et al. Effects of 24-hours/day versus business hours physical therapy intervention in adult intensive care unit patients: a systematic review. Int Phys Med Rehabil J. 2018;3(1):100-6. | CrossRef |

Haines TP, Bowles KA, Mitchell D, O'Brien L, Markham D, Plumb S, et al. Impact of disinvestment from weekend allied health services across acute medical and surgical wards: 2 stepped-wedge cluster randomised controlled trials. PLoS Med. 2017 Oct 31;14(10):e1002412. | CrossRef | PubMed |

Mills E, Hume V, Stiller K. Increased allied health services to general and acute medical units decreases length of stay: comparison with a historical cohort. Aust Health Rev. 2018 Jun;42(3):327-333. | CrossRef | PubMed |

Intensive Care Society. Core Standards for Intensive Care Units. Core Stand Intensive Care Units. 2013;1:1-27. | Link |

Wright SE, Thomas K, Watson G, Baker C, Bryant A, Chadwick TJ, et al. Intensive versus standard physical rehabilitation therapy in the critically ill (EPICC): a multicentre, parallel-group, randomised controlled trial. Thorax. 2018 Mar;73(3):213-221. | CrossRef | PubMed |

Johnson AM, Henning AN, Morris PE, Tezanos AGV, Dupont-Versteegden EE. Timing and Amount of Physical Therapy Treatment are Associated with Length of Stay in the Cardiothoracic ICU. Sci Rep. 2017 Dec 14;7(1):17591. | CrossRef | PubMed |

Stone SA. Staffing levels: give us a tool for optimum staffing levels. 2018. csp.org.uk [on line]. | Link |

Allied Health Professions the Workforce and the Services They Provide. 2017;(March). | Link |

Cartmill L, Comans TA, Clark MJ, Ash S, Sheppard L. Using staffing ratios for workforce planning: Evidence on nine allied health professions. Hum Resour Health. 2012;10:1-8. | Link |

Skinner EH, Haines KJ, Berney S, Warrillow S, Harrold M, Denehy L. Usual Care Physiotherapy During Acute Hospitalization in Subjects Admitted to the ICU: An Observational Cohort Study. Respir Care. 2015 Oct;60(10):1476-85. | CrossRef | PubMed |

Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med. 2014 May;42(5):1178-86. | CrossRef | PubMed |

Berney SC, Harrold M, Webb SA, Seppelt I, Patman S, Thomas PJ, et al. Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resusc. 2013 Dec;15(4):260-5. | PubMed |

Berney SC, Rose JW, Bernhardt J, Denehy L. Prospective observation of physical activity in critically ill patients who were intubated for more than 48 hours. J Crit Care. 2015 Aug;30(4):658-63. | CrossRef | PubMed |

Connolly BA, Mortimore JL, Douiri A, Rose JW, Hart N, Berney SC. Low Levels of Physical Activity During Critical Illness and Weaning: The Evidence-Reality Gap. J Intensive Care Med. 2017 Jan 1:885066617716377. | CrossRef | PubMed |

Grammatopoulou E, Charmpas TN, Strati EG, Nikolaos T, Evagelodimou A, Vlassia Belimpasaki, Skordilis EK. The scope of physiotherapy services provided in public ICUs in Greece: A pilot study. Physiother Theory Pract. 2017 Feb;33(2):138-146. | CrossRef | PubMed |

Norrenberg M, Vincent JL. A profile of European intensive care unit physiotherapists. European Society of Intensive Care Medicine. Intensive Care Med. 2000 Jul;26(7):988-94. | CrossRef | PubMed |

Campbell L, Bunston R, Colangelo S, Kim D, Nargi J, Hill K, et al. The provision of weekend physiotherapy services in tertiary-care hospitals in Canada. Physiother Can. 2010 Fall;62(4):347-54. | CrossRef | PubMed |

Griffiths P, Ball J, Murrells T, Jones S, Rafferty AM. Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: a cross-sectional study. BMJ Open. 2016 Feb 9;6(2):e008751. | CrossRef | PubMed |

National Quality Board. An improvement resource for urgent and emergency. 2017;(November). | Link |

Haupt MT, Bekes CE, Brilli RJ, Carl LC, Gray AW, Jastremski MS, et al. Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care. Crit Care Med. 2003 Nov;31(11):2677-83. | CrossRef | PubMed |

Fisher ME, Aristone MN, Young KK, Waechter LE, Landry MD, Taylor LA, et al. Physiotherapy Models of Service Delivery, Staffing, and Caseloads: A Profile of Level I Trauma Centres across Canada. Physiother Can. 2012 Fall;64(4):377-85. | CrossRef | PubMed |