Out-of-Hours Service Models for Acutely Deteriorating Respiratory Patients: A Scoping Review

Background Acute respiratory deterioration in hospitalised patients requires timely intervention to prevent further clinical decline. Out-of-hours respiratory care is typically provided through on-call physiotherapy rotas, extended hour cover, or 24/7 on-site services. However, models of care vary widely internationally, and little is known about how these services are structured, delivered, and evaluated for acutely deteriorating respiratory patients. Objectives To map and describe international models of care for out-of-hours services for acutely deteriorating respiratory patients, including key model characteristics, workforce configurations, referral processes, reported barriers and facilitators, and associated outcomes. Methods A scoping review was undertaken following the Joanna Briggs Institute and PRISMA-ScR guidance. This included a comprehensive search of electronic databases and grey literature. Papers were included if they reported models of out-of-hours care relevant to respiratory physiotherapy or multidisciplinary care for patients with acute respiratory deterioration. Data were extracted independently by four reviewers and synthesised descriptively using a narrative approach. Results Thirteen international papers published between 2002 and 2023 were included. The majority (77%) described out-of-hours physiotherapy models; others reported extended hours or multidisciplinary rapid response teams. Operating hours, referral processes, and protocols varied widely, with many services relying on non-specialist physiotherapists for out-of-hours provision. Barriers to service provision included staffing limitations, variability in competence, and organisational challenges. Facilitators included presence of senior support, structured training, protocols, and institution support for extended hours models. Evidence on clinical outcomes was limited and heterogeneous. Conclusions Out-of-hours care for acutely deteriorating respiratory patients is delivered through a range of models internationally, with considerable variation in structure and workforce configuration. Further research is needed to evaluate model effectiveness, impact on staff well-being, and relevance to evolving workforce demands.