Does cutting weekend allied health services hurt patients?

Removing weekend allied health services--including physical therapy, occupational therapy, speech therapy, dietetics, and social work--from the surgical wards of hospitals had little effect on patients' outcomes, according to a study published this week in PLOS Medicine by Terry Haines of Monash University, Victoria, Australia, and colleagues.

The removal of a heath care service to save resources can be difficult when there is little published evidence on the effectiveness of the service. In the new study, current weekend allied health services were incrementally removed--in a random order--from 12 acute surgical or medical wards in two hospitals in Melbourne, Australia. Then, newly developed, more tailored services were reintroduced incrementally into the same wards.

There was little difference between having no weekend allied health services and having the reintroduced services--indeed, having no services was beneficial for the measures of patient length of stay (2% better with no services, 95% confidence interval [CI] 1% to 5%) and adverse events (3% fewer with no services, 95% CI 0% to 5%). Removing the current weekend services had an uncertain impact of patient length of stay (+1%, 95% CI -1% to +4%) and adverse events (+1%, 95% CI -1% to +3%). The findings may not apply to all surgical and medical wards, such as those with specialty units.

"The key implication of this research is that resources being used to support weekend allied health service delivery to acute medical and surgical wards similar to those involved in this study could potentially be put to better use elsewhere in the health care system," the authors say.

In an accompanying Perspective, Aziz Sheikh of the University of Edinburgh, UK, notes that a key advantage of the trial design was its ability--with the incremental reinstating of more tailored programs--to quell some of the usual concerns surrounding the withdrawal of services. "This approach has the potential to be extended to a whole range of other services that are currently delivered as routine care, but which have a questionable underpinning evidence base," he says.

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This research was funded by the National Health and Medical Research Council (AU) Award Number: 1060696 (TH, ES, FM, LO, DMa, DMi), the National Health and Medical Research Council (AU) Award Number: 1069758 (TH), the Department of Health, State Government of Victoria (TH), and the Australian Government Postgraduate Award (RH and MS). KP worked for the Victorian Department of Health and Human Services and contributed to study design and manuscript preparation as an author. The funders had no other role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

I have read the journal's policy and the authors of this manuscript have the following competing interests: RH has been funded by an Australian Postgraduate Awards Scholarship. KM is a board member (volunteer/unpaid) for Wounds Australia and a member of Victorian Allied Health Leaders Council Executive (unpaid).

Haines TP, Bowles K-A, Mitchell D, O'Brien L, Markham D, Plumb S, et al. (2017) Impact of disinvestment from weekend allied health services across acute medical and surgical wards: 2 stepped-wedge cluster randomised controlled trials. PLoS Med 14(10): e1002412. https://doi.org/10.1371/journal.pmed.1002412

Author Affiliations:

Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
Monash Medical Centre, Allied Health, Monash Health, Clayton, Victoria, Australia
Royal Melbourne Hospital, Melbourne, Victoria, Australia
Department of Health and Human Services, Melbourne, Victoria, Australia
Department of Physiotherapy, Footscray Hospital, Western Health, Footscray, Victoria, Australia
Footscray Hospital, Western Health, Footscray, Victoria, Australia
Institute of Biomedical Innovation, Queensland University of Technology and Centre for Functioning and Health Research, Buranda, Queensland, Australia
Department of Social Work, Monash Medical Centre, Monash Health and Monash University, Clayton, Victoria, Australia

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002412

The author received no specific funding for this work.

AS is a member of the Editorial Board of PLOS Medicine.

Sheikh A (2017) Decommissioning care: The need for rigorous multifaceted evaluations of decisions to withdraw health services. PLoS Med 14(10): e1002413. https://doi.org/10.1371/journal.pmed.1002413

Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

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