Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review

Dr Mitchell Sarkies1

1Curtin University; Monash University,

BACKGROUND: The routine provision of additional allied health services during weekends is variable across hospitals both in Australia and worldwide. It is unclear whether providing these services is beneficial. The aim of this review was to synthesise available evidence examining the effectiveness and cost-effectiveness of providing additional weekend allied health services to patients on acute general medical and surgical hospital wards, and subacute rehabilitation hospital wards.

METHOD: A systematic review and meta-analysis of studies published between January 2000 and May 2017 was conducted. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Meta analyses were conducted for relative measures of effect estimates. Studies were included if they focussed on patients admitted to acute general medical and surgical wards, and subacute rehabilitation wards. Interventions of focus were all services delivered by allied health professionals during weekends. This study limited allied health professions to: occupational therapy, physiotherapy, social work, speech pathology, dietetics, art therapy, chiropractic, exercise physiology, music therapy, oral health (not dentistry), osteopathy, podiatry, psychology, and allied health assistants. Outcome measures of interest included: hospital length of stay, hospital re-admission, adverse events, discharge destination, functional independence, health related quality of life, and cost of hospital care.

RESULTS: Nineteen articles (20 studies) were identified, comprising 10 randomised and 10 non-randomised trials. 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%), and 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.

CONCLUSION: The benefit of providing additional allied health services is clearer in subacute rehabilitation settings than for acute general medical and surgical wards in hospitals.


Biography:

Mitchell Sarkies is a physiotherapist and health services researcher who is interested in the implementation of evidence into healthcare policy and practice.

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