Barriers to Respiratory Therapist-Led Weaning Clinics in Saudi Hospitals: A Multi-Centre Cross-Sectional Study

Abstract

Background: Respiratory therapist (RT)-led weaning clinics have demonstrated measurable reductions in ventilator duration and ICU length-of-stay in North America and Europe, yet no such programme exists in Saudi Arabia. The structural, professional, and systemic determinants of this gap remain undefined.

Objective: To identify and rank perceived barriers to implementing RT-led weaning clinics across Saudi hospitals and to determine whether barriers differ by hospital type and clinician experience.

Methods: A descriptive cross-sectional survey was administered to 278 registered RTs practising in accredited Saudi hospitals across four regions (Riyadh, Jeddah/Mecca, Eastern Province, Northern/Southern) from October to December 2024. A validated 35-item barrier instrument (5-point Likert) was supplemented by an open-ended qualitative component. One-way ANOVA, Tukey post-hoc tests, and multiple linear regression were used for quantitative analysis; directed content analysis was applied to qualitative data.

Results: The overall response rate was 74.5%. The highest-rated barrier was physician resistance to RT-led role delegation (mean = 4.31 ± 0.61), followed by staffing deficiencies (4.18 ± 0.68) and absence of standardised protocols (4.09 ± 0.72). Composite barrier scores were significantly higher in tertiary government hospitals than in private facilities (F = 7.14, p < .001, η²p = 0.15). Hospital type (β = 0.31) and years of clinical experience (β = 0.28) were the strongest predictors of perceived barrier severity (Adjusted R² = 0.38). Five qualitative themes emerged: medical hierarchy, staffing burden, protocol gaps, educational deficits, and regulatory ambiguity.

Conclusion: Physician-RT role negotiation, workforce capacity, and national regulatory frameworks are the highest-priority leverage points for policy. The findings provide actionable evidence for the Saudi Commission for Health Specialties and hospital leadership to advance RT-led ventilator weaning services.