Browsing by Author "Fu, Carolina"
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Item 24/7 Physical Therapy Intervention With Adult Patients in a Chilean Intensive Care Unit: A Cost-Benefit Analysis in a Developing Country(2020) Merino, Catalina; Velásquez, Mónica; Marmolejo, José Ignacio; Fu, CarolinaObjectives: Physiotherapy in an adult intensive care unit (ICU) affects health outcome. To justify the investment in ICU physical therapy, the cost savings associated with its benefits need to be established. The main objective of this study is to evaluate the potential cost savings of implementing 24-hour, 7-days-per-week physiotherapist (24/7-PT) in a Chilean public high-complex specialized ICU. Methods: Using clinical data from a literature review and a micro-costing technique, we conducted a cost-benefit analysis in the National Institute of Thorax in Chile. Our example scenario involves 697 theoretical admissions of adult patients with cardiovascular or respiratory diseases, and the costs and benefits by reduction of length of stay in ICU, days of mechanical ventilation, and days with respiratory infections during the first year and 5 years of admissions. A sensitivity analysis was considered according to the variability in total costs, production income, and clinical benefits. Results: Net cost savings generated in our example scenario demonstrate that the implementation of 24/7-PT produces a minimum saving for the institution of $16 242 during the first year and $69 351 over a 5-year interval considering individual income production. Out of the 30 scenarios included in the sensitivity analyses, 26 (87%) demonstrated net savings. Conclusions: A financial model, based on literature review and actual cost data, projects that 24/7-PT intervention is a costbenefit alternative in adult ICU patients with cardiovascular or respiratory diseases in Chile. It is necessary a scenario of at least 3 sessions per day with insurance payment for individual treatments to support the long-term implementation of a 24/7-PT program.Item Characteristics of physiotherapy staffing levels and caseload: a cross-sectional survey of Chilean adult Intensive Care Units(2019) Aranis, Nadine; Molina, Jorge; Leppe, Jaime; Castro, Ana; Fu, Carolina; Merino, CatalinaIntroduction: The European Society of Intensive Care Medicine recommends the presence of a specialist physiotherapist, available every five beds, seven days a week in the high complexity Intensive Care Unit. However, in Chile the adherence of adult Intensive Care Units to this recommendation is unknown. Objective: To describe the organizational characteristics and the physiotherapist availability in adult Intensive Care Units in Chile, and according to the adherence to international recommendations, inform health decision-makers. Methods: Observational study based on a telephone survey. All adult Intensive Care Units institutions of high complexity, private hospitals and teaching health centers in Chile were eligible (n = 74). The primary outcome measures were the proportion of institutions with physiotherapist availability 24 hours a day and seven days a week (24/7 physiotherapist), a maximum caseload per physiotherapist of five patients and the presence of a specialist physiotherapist. Results: Response rate was 86.5%, with 59% of responding units being public and 83% offering level III care. 70% of the adult Intensive Care Units in Chile have 24/7 physiotherapist (87% of the public and 46% of the private sector). 41% of the centers had a maximum caseload per physiotherapist of five patients during the day on weekdays. This number decreased on weekends and during night shifts. 23% of the Intensive Care Units had a specialist physiotherapist, being more common in the private sector (31%). Conclusions: In Chilean adult ICU, 24/7 physiotherapist availability is high, the prevalence of physiotherapists with specialist training is low. Future efforts should focus on promoting the uptake of specialist training.Item Effects of 24-hours/day versus business hours physical therapy intervention in adult intensive care unit patients: a systematic review care unit patients(2018) Merino, Catalina; Castro-Ávila, Ana Cristina; Gutiérrez-Arias, Ruvistay; Arriagada, María Jesús; Villanueva, Catalina; Leppe, Jaime; Fu, CarolinaBackground: Some evidence suggests that higher doses of mobilization could have benefits on functional status. However, the impact of increasing the availability of Physical Therapist in the intensive care unit to provide critical care for these conditions is unclear. Objective: to determine the effect of physical therapy 24-hour/7days on the length of stay, index of respiratory system infection, days of mechanical ventilation, mortality and quality of life, in adult patients admitted to an intensive care unit. Methods and design: The databases EMBASE, MEDLINE, PUBMED, and reference lists of previous reviews were searched for clinical trials and observational studies, without restriction on language or publication date. Four reviewers independently screened articles for eligibility, and included studies were appraised using the ROBINS-I risk of bias tool for non-randomised studies. Results: 4509 records were screened. Two prospective cohorts were included in the review. Both studies reported significant improvements in length of intensive care unit stay and days of mechanical ventilation, while the index of respiratory system infection and mortality had unclear improvement. No studies reported quality of life in patients. Conclusion: There was insufficient robust data to conclude that increasing availability of physical therapy beyond business hours could shorten the length of ICU stay and days of mechanical ventilation. Further studies are required to increase certainty about the effectiveness of Physical Therapist intervention 24-hours/7 days in intensive care unit.