Patterns of use of chest physiotherapy in a teaching hospital.

Studies of chest physiotherapy in medical patients have consistently shown benefit only in patients who produce large amounts of sputum. Among surgical patients systematically repeated maximal inspiration is the only procedure that clearly reduces the incidence of post-operative pulmonary complications. Rationalization of the use of physiotherapy requires data on the pattern of its use. To obtain such data an audit was conducted on the use of physiotherapy in patients discharged from Royal Newcastle Hospital in October 1989. It was suspected that respiratory physicians would account for the bulk of chest physiotherapy. All patients admitted under respiratory physicians and random samples of patients admitted under other physicians and under surgical specialists were surveyed. Chest physiotherapy was ordered in 13/44 (30%) patients cared for by respiratory physicians, 5/45 (11%) other medical patients and 11/48 (23%) surgical patients (P = 0.049). Chest physiotherapy was ordered in 28 of 29 instances for conditions in which it is of no proven benefit. From the total numbers of medical and surgical patients it was estimated that 71% of chest physiotherapy referrals in October 1989 were for non-medical patients. About half of all referrals were initiated by junior medical staff. Much of the chest physiotherapy performed in the hospital was unlikely to have been of major clinical value and patients with respiratory illnesses were minor consumers of chest physiotherapy. Attempts to reduce wasteful overuse of chest physiotherapy may be most effective if directed at physiotherapists. If medical staff are targeted it would be essential to reach those attached to surgical units.