Physiotherapy service provision in a specialist adult cystic fibrosis service: a pre-post design study with the inclusion of an allied health assistant.

Hall, K. A.; Maxwell, L.; Cobb, R.; Steele, M.; Chambers, R.; Roll, M.; Bell, S.; Kuys, S.

ABSTRACT Question(s): What is the impact of including an allied health assistant (AHA) role on physiotherapy service delivery in terms of service provision, scope of practice and skill mix changes in an acute respiratory service? Design: A pragmatic pre-post design study examined physiotherapy services across two three-month periods: current service delivery [P1] and current service delivery plus AHA [P2]. Outcome measures: Clinical and non-clinical activity contributing to physiotherapy services delivery quantified as number, type and duration (per day) of all staff activity, and categorised for skill level (AHA, junior, senior). Results: Overall physiotherapy service delivery increased in P2 compared to P1 (n=4730 vs n=3048). Physiotherapists undertook fewer respiratory (p < 0.001) and exercise treatments (p < 0.001) but increased patient reviews for inpatients (p < 0.001) and at multidisciplinary clinics in P2 (56% vs 76%, p < 0.01). The AHA accounted for 20% of all service provision. AHA activity comprised mainly non-direct clinical care including oversight of respiratory equipment use (e.g. supply, set-up, cleaning, loan audits) and other patient related administrative tasks associated with delegation handovers, supervision and clinical documentation (72%) and delegated supervision of established respiratory (5%) and exercise treatments (10%) and delegated exercise tests (3%). The AHA completed most of the exercise tests (n = 25). AHA non-direct clinical tasks included departmental management activities such as statistics and ongoing training (11%). No adverse events were reported. Conclusion: Inclusion of an AHA in an acute respiratory care service changed physiotherapy service provision. The AHA completed delegated routine clinical and non-clinical tasks. Physiotherapists increased clinic activity and annual reviews. Including an AHA role offers safe and sustainable options for enhancing physiotherapy service provision in acute respiratory care services.