Access to allied health services, in particular, physiotherapy, on weekends should be standard in the subacute rehabilitation setting, according to Australian Physiotherapy Association member Mitchell Sarkies, following new research which identified numerous benefits from doing so.

“The identified benefits of improved patient function and health-related quality of life during shorter hospital length of stay indicate that increased rehabilitation efficiency is achievable using this model of care,” said Mr Sarkies.

“Further, the reduced hospital length of stay in subacute rehabilitation wards can improve patient flow in acute wards and contribute to improved cost-effectiveness.”

The study came after two Australian surveys reported between 43-61% of acute hospitals, and 30-53% of sub-acute hospitals provided limited physiotherapy services during weekends.

“What is interesting is the disparity between certain hospitals and wards types,” said Mr Sarkies.

“Acute, metropolitan and private hospitals are more likely to provide weekend physiotherapy than subacute, regional and public hospitals.

“Given the breadth of diversity in the provision of weekend allied health services in Australian hospitals, we sought to synthesise the available evidence examining the effectiveness and cost-
effectiveness of providing additional weekend allied health services to patients on acute general medical and surgical wards, and subacute rehabilitation wards.”

Physiotherapy was the most commonly investigated profession, along with occupational therapy, speech pathology, dietetics, and social work.

“There was a large variety in how allied health services were provided during weekends. Some studies trialled 6-days per week (additional Saturday services), while others trialled 7-days per week (additional Saturday and Sunday services).”

Patients were included if they were admitted to an acute general medical and surgical ward limited to: general medical, general surgical, medical assessment unit, orthopaedic, vascular, plastics, ear nose and throat, thoracic, respiratory, coronary care unit, renal, rheumatology, neurology (including stroke units), infectious diseases, colorectal, endocrine, urological, and gastroenterology.

Results showed that additional weekend allied health services in sub-acute rehabilitation wards reduced hospital length of stay by 2.35 days, and may also be a cost-effective way to improve
function and health-related quality of life.

“The reduction in hospital length of stay by providing access to weekend allied health in subacute rehabilitation wards was not surprising,” said Mr Sarkies.

“However, the inability to conclude that routinely using a weekend allied health model to provide additional services in the acute general medical and surgical ward setting would achieve intended benefits for all patients was a surprising result for our team.

“Previous studies and systematic reviews have indicated that providing earlier, additional, or higher intensity allied health services can improve health outcomes.

“It is now clear that these benefits occur in subacute rehabilitation wards when weekend allied health staffing models are used to deliver additional services on a routine basis.

“Future studies could consider whether alternative models have the potential to deliver cost-effective weekend allied health services.”

The study did not examine why the benefits of weekend allied health service provision were clearer in subacute rehabilitation settings than for acute general medical and surgical wards in hospitals.

“It may be that patients are generally less medically unwell once they have been discharged from an acute ward to a subacute ward and can participate more in rehabilitation therapy.”