By Gareth Cornell, Clinical Specialist Physiotherapist in Critical Care
What is a Clinical Specialist Physiotherapist (CSP) in Critical Care? Physiotherapy in Critical Care is a well-established role, but we are still learning the depth and breadth of the impact we can have on a patient’s journey through Critical Care and beyond.
Traditionally, the role may have been directed more around ‘chest physiotherapy’. Over time greater emphasis has been placed upon the value of rehabilitation. A modern-day Critical Care Physiotherapist is required to be expert in both advanced respiratory care and complex, often specialist, rehabilitation.
As a physiotherapist, in our case ‘General’ Critical Care actually means ‘Multi-Specialist’.
In Sheffield, the General Critical Care at Northern General Hospital is on the large side – 36 Intensive Care Unit and HDU (High Dependency Unit) beds split into two units. We are the Major Trauma centre, Heart Attack centre, and offer many more specialist services for the region. This makes for a busy and diverse Critical Care unit.
As a physiotherapist, in our case ‘General’ Critical Care actually means ‘Multi-Specialist’. We are accustomed to caring for patients following head injury, spinal cord injury, complex polytrauma, burns, cardiac arrest, as well as post-operative care for a wide variety of surgical specialities, and not forgetting the broad spectrum of acute medical conditions. I clinically lead a team of Band 6 and Band 5 physiotherapists to provide dedicated cover to the Critical Care unit.
I am also fortunate to hold a committee position with the ACPRC (Association of Chartered Physiotherapists in Respiratory Care), one of the CSP’s Professional Networks, and have recently begun participating in our regional Critical Care Operational Delivery Network.
How do you approach your work?
I think most of my colleagues would agree with the statement: “pretty full-on”. Lots of ideas, lots of projects, always pushing forwards.
Clinically, I would say more and more open-minded as time goes by. A quote one Critical Care Consultant impressed upon me is “the more you see the less you know”. There is always a myriad of clinical and contextual information to consider. It is important to be able to take a wide view then narrow in on how to make the biggest impact with your interventions.
I believe wholeheartedly that we all should be learning every day, and I try my best to create a positive environment for the team to challenge each other to be better.
Can you give us a tour of your normal workday?
The day starts off with morning MDT handover on ICU or HDU followed by team organisation for the day ahead.
Teaching within clinical practice as much as possible with Band 6 or 5 staff, in addition to my own clinical caseload of the more complex cases. Then it’s time for the MDT Consultant-led ward round. Afternoons are often filled with responsibilities such as teaching, staff supervision, or various meetings around service improvement or clinical governance. Currently, we are trying to equip ourselves better for undertaking clinical research.
What are the highs…?
Working as part of both a really close-knit Therapy team, as well as a multi-disciplinary team.
Educating the minds of tomorrow and positively challenging the status quo.
On our unit recently it has been great to see both patients and staff alike be inspired by the evolving culture of rehabilitation and recovery
And in the nicest possible way, seeing patients leave the unit, especially those with protracted Critical Care admissions. The majority of patients admitted to Critical Care go through such arduous journeys. It is rewarding knowing the impact you have made helping that patient from admission to discharge.
On our unit recently it has been great to see both patients and staff alike be inspired by the evolving culture of rehabilitation and recovery; e.g. assisting a patient still requiring mechanical ventilation to shower, walk outside, or use an exercise bike.
The past two years working the ACPRC has also opened up so many opportunities to engage in invaluable forums and champion the role of physiotherapy in Critical Care.
…and the challenges?
I think very similar to other factions of the MDT – resources! Whether that be staff, equipment or time.
Along with countless others we are all trying to deliver better care and services. Unfortunately, more often than not we are left feeling we could do more each patient, if only certain gaps could be addressed or barriers overcome.
There is so much variability around the UK regarding physiotherapy service provision in Critical Care. A wider issue is building the workforce capability for Critical Care. Many units will likely have only the physiotherapy posts commissioned long ago, rather than those matched to modern service demands.
Efforts are required to address the numbers, skills, and career pathways for physiotherapists advancing in Critical Care.
Some of the healthy challenges ahead are addressing the evidence-base behind many areas of our practice in Critical Care, embracing what new technology may offer in rehabilitation and respiratory care, and establishing which patient outcomes to focus upon to enable better evaluation of services and research.
Is there anything you would like to change in the Critical Care world?
Things will continue to evolve, and practice will develop over time according to the demands we face. In the short-term, equipping Critical Care services with AHP’s with the right skills is a priority, embracing the diverse talents that roles such as Occupational Therapy and Clinical Psychology offer, as well as recognising the value of Rehabilitation Assistants.
Secondly, a closer spotlight needs shining on the highly variable pathways of care patients face following discharge from Critical Care.
Interested in what you see here?
Register here to attend our Careers Day and meet with colleagues working in many different Intensive Care roles.