November 30, 2017 / 9:46 PM / 3 years ago

Some hospital services may be expendable on weekends

(Reuters Health) - Removing allied healthcare services from hospitals on weekends may not affect patient outcomes, suggests a new Australian study.

Allied health services involve healthcare providers who aren’t doctors or nurses - such as physical therapists, social workers, and dietitians, for example.

Resources spent on providing allied health services on weekends in acute medical and surgical wards could possibly be better spent elsewhere, say the authors.

“In-hospital allied health services complement medical and nursing services throughout a hospital journey. Allied health is now present in emergency departments, intensive care units, general medical and surgical wards, rehabilitation, oncology and a range of other specialty ward types,” study leader Terry Haines at Monash University in Victoria told Reuters Health by email.

“Understanding (the) tasks and settings in which they provide the greatest value for money for society is a difficult task,” he said.

Weekend allied health services on acute medical and surgical wards started becoming popular internationally around two decades ago, but this was not driven by well-designed research, according to Haines.

“Once a health (facility) has committed to providing this service, it is very difficult to remove. . . . Trials like ours provide an evidence base that should have been created two decades ago before these services were implemented so broadly,” Haines said.

As reported in PLoS Medicine, Haines and his colleagues conducted two trials over the course of about a year, involving almost 15,000 patients.

First, weekend allied health services were incrementally removed from 12 acute surgical or medical wards in two hospitals in Melbourne.

Next, researchers asked doctors, nurses and allied health staff to identify and prioritize the most important tasks for allied health services to provide on weekends. Based on those interviews, newly redeveloped services were reintroduced incrementally into the same wards.

The researchers found that removing allied health services didn’t appear to affect the time patients spent in the hospital and didn’t seem to impact safety issues.

In addition, adding the new services back didn’t seem to improve outcomes. In fact, the proportion of patients who stayed longer than expected, and the proportion of patients who had any adverse event, were slightly lower without weekend allied care.

Health services should be actively trying to find areas where the resources they allocate are not delivering the intended outcomes, Haines said.

“There is some evidence from randomized trials available that allied health services delivered on rehabilitation wards can be effective for improving health outcomes and reducing the length of stay. It could be a simple case of moving allied health resources from the acute medical and surgical wards over to the rehabilitation wards,” he said.

There are many different ways that weekend allied health services can be structured on acute medical and surgical wards, said Haines.

“We did not investigate all these possibilities, rather, we looked at both the pragmatic question of what was currently being provided at the time . . . and what our local managers thought might be the theoretically best way to allocate the same amount of resources available,” he said.

A physiotherapist who was not involved in the research told Reuters Health by email that the study answers some questions but it raises others.

Nicole Bellet, Director of Physiotherapy at the Prince Charles Hospital in Chermside, Queensland, Australia, said some services are best provided by “staff trained and interested in the tasks being delegated.”

There is an argument, she said, for ancillary services on weekends, especially in rehabilitation wards and surgical wards where reduced mobility may mean patients go backwards over the weekend.

“Weekend service for physiotherapy is important for those instances where respiratory function is at risk, mobility and the progression of this is important for patient outcomes and discharge planning,” she added.

“However, there is also the need for the patients to rest, visit with family, trial home stay, etc. So, in essence I believe this paper provides only a small part of the puzzle and hopefully more work will be done in this area,” she said.

SOURCE: PLoS Medicine, online October 31, 2017.

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