Transferring weekend allied health services from the acute to sub-acute setting

Ms Romi Haas1,2, Dr Kelly-Ann Bowles1,3, Dr Lisa O’Brien1,4, Professor Terry Haines1,2

1Monash University Department of Physiotherapy, Frankston, Australia, 2Monash Health Allied Health Research Unit, Cheltenham, Australia, 3Monash University Department of Community Emergency Health and Paramedics, Frankston, Australia, 4Monash University Department of Occupational Therapy, Frankston, Australia

Aim: To investigate the effect of transferring weekend allied health services from the acute to sub-acute setting on patient and service outcomes following hip and knee replacement surgery.

Method: A quasi-experimental study was conducted at a public tertiary hospital in Melbourne, Victoria, Australia.  Patient and service outcomes for patients undergoing elective or revision total hip and knee replacement (N=276) were compared during a six-month period of acute weekend allied health services (n=130) followed by a subsequent six-months when these services were transferred to the sub-acute setting (n=146). Outcome measures included mobility, functional independence, quality of life and pain (at six weeks postoperatively) and hospital length of stay, adverse events, unplanned hospital readmission and profession of staff assisting with first postoperative transfer.

Results: Approximately 20% more of first postoperative transfers were assisted by nurses rather than physiotherapists when acute weekend allied health services were not available [x2 (4, N=276)=16.94, p=0.002]. There was no difference in total length of stay between the two phases [log transformed coefficient=-0.011 (95% CI -0.038 to 0.015), p=0.396].  The reduction in acute length of stay observed when acute weekend allied health services were not available was not significant [log transformed coefficient=0.019 (95% CI -0.001 to 0.039), p=0.069].

Significance of the findings to allied health: Transferring weekend allied health services from the acute to sub-acute setting may have provided a stimulus for increased nurse involvement in early postoperative mobilisation without affecting patient outcomes.  Further research