Additional weekend allied health services in hospitals
In this study, a detailed look has been taken at whether additional weekend allied health services are effective and cost-effective for acute general medical and surgical wards, and for subacute rehabilitation hospital wards.
To determine this, the data from 10 randomised trials and 10 non-randomised trials were pooled. Although randomised trials provide more robust evidence, the authors of this systematic literature review realised that interventions like institution-wide staffing levels are difficult to randomise, so they also considered large-scale non-randomised studies.
To satisfy the purists, who might want to see only the results of the randomised trials, the authors of this systematic review pooled the results of the randomised studies separately from those of the non-randomised studies.
A range of outcome measures were considered in the review, including hospital length of stay, hospital re-admission, adverse events, discharge destination, functional independence, health-related quality of life, and cost of hospital care. Wherever these data were reported in a paper, the data were extracted and pooled with the corresponding outcome data from the other papers.
Physiotherapy was the most commonly investigated profession. A meta-analysis of randomised, controlled trials showed that providing additional weekend allied health services in subacute rehabilitation wards reduced hospital length of stay by 2.35 days (95% CI 0.45 to 4.24, I² = 0%). The pooled data also showed that additional weekend allied health services may be a cost-effective way to improve function (SMD 0.09, 95% CI –0.01 to 0.19, I² = 0%), and health-related quality of life (SMD 0.10, 95% CI –0.01 to 0.20, I² = 0%).
For acute general medical and surgical hospital wards, it was unclear whether the weekend allied health service model provided in the two identified randomised trials led to significant changes in measured outcomes. The authors concluded that the benefits of routinely providing additional allied health services on subacute rehabilitation wards are clearer than in the acute general medical and surgical ward setting.
Future studies are required to further investigate the effect of targeted weekend allied health services. However, the goals of care for weekend allied health service provision may differ between acute and subacute hospital ward settings, and should therefore be reflected in the outcomes evaluated in future studies.
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> From: Sarkies et al., J Physiother 64 (2018) 142-158 (Epub ahead of print). All rights reserved to the Australian Physiotherapy Association. Click here for the online summary.