Increased allied health services to general and acute medical units decreases length of stay: comparison with a historical cohort*
Ellen Mills A B , Vicki Hume A and Kathy Stiller AA Central Adelaide Local Health Network, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Email: Vicki.Hume@sa.gov.au; Kathy.Stiller@sa.gov.au
B Corresponding author. Email: Ellen.Mills@sa.gov.au
Australian Health Review 42(3) 327-333 https://doi.org/10.1071/AH16220
Submitted: 6 October 2016 Accepted: 17 February 2017 Published: 30 March 2017
Abstract
Objective The present study evaluated the effect of an initiative to fund increased allied health (AH) services, enabling increased days and both volume and scope of AH services, for general medical in-patients in the Central Adelaide Local Health Network for a 6-month trial period.
Methods A quasi-experimental mixed-methods study was undertaken involving general medical in-patients at two acute tertiary-referral public hospitals with a prospective (December 2015–May 2016) and historical comparison (December 2014–May 2015) cohort. Outcome measures compared between the two cohorts included hospital length of stay (LOS), occupied bed-days, adverse events and AH service data.
Results After implementation of increased AH services, there were significant decreases in the median (interquartile range) of both hospital LOS (from 7.2 (7.0–8.0) to 6.5 (6.1-6.7) days; P = 0.006) and occupied bed-days (from 5295.0 (5200.0–5622.3) to 4662.5 (4335.8–4744.3) bed-days per month; P = 0.004). There was no significant change in weekend discharges or adverse events. AH services increased, with the median number of referrals seen by AH professionals per month, occasions of AH service and AH intervention time per month increasing by 17%, 45% and 43% respectively after implementation, along with a faster response time to referrals.
Conclusions Increased levels of AH staffing to general medical in-patients were associated with a significant reduction in hospital LOS and occupied bed-days.
What is known about the topic? AH services are an important component in the delivery of safe, effective and efficient health care to hospitalised patients. There is little evidence specifically investigating the effect of increased AH services for general medical patients in an acute hospital setting.
What does this paper add? This study provides new evidence demonstrating that increasing AH services to general medical in-patients within two acute tertiary-referral public hospitals decreased hospital LOS and occupied bed-days, without an increase in adverse events.
What are the implications for practitioners? A funding initiative to enable increased AH services to general medical in-patients significantly reduced hospital LOS and occupied bed-days. These findings will be of considerable interest to other healthcare centres, particularly those where AH levels are below benchmark figures.
Additional keywords: allied health personnel, health care facilities, hospital medicine, manpower, services.
References
[1] Brusco NK, Paratz J. The effect of additional physiotherapy to hospital inpatients outside of regular business hours: a systematic review. Physiother Theory Pract 2006; 22 291–307.| The effect of additional physiotherapy to hospital inpatients outside of regular business hours: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[2] Haines TP, O’Brien L, Mitchell D, Bowles KA, Haas R, Markham D, Plumb S, Chiu T, May K, Philip K, Lescai D, McDermott F, Sarkies M, Ghaly M, Shaw L, Juj G, Skinner EH. Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services. Trials 2015; 16 133
| Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services.Crossref | GoogleScholarGoogle Scholar |
[3] Hakkennes S, Lindner C, Reid J. Implementing an inpatient rehabilitation Saturday service is associated with improved patient outcomes and facilitates patient flow across the health care continuum. Disabil Rehabil 2015; 37 721–7.
| Implementing an inpatient rehabilitation Saturday service is associated with improved patient outcomes and facilitates patient flow across the health care continuum.Crossref | GoogleScholarGoogle Scholar |
[4] Peiris CL, Taylor NF, Shields N. Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review. Arch Phys Med Rehabil 2011; 92 1490–500.
| Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[5] Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF. Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial. BMC Med 2013; 11 198
| Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |
[6] Scrivener K, Jones T, Schurr K, Graham PL, Dean CM. After-hours or weekend rehabilitation improves outcomes and increases physical activity but does not affect length of stay: a systematic review. J Physiother 2015; 61 61–7.
| After-hours or weekend rehabilitation improves outcomes and increases physical activity but does not affect length of stay: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[7] Cartmill L, Comans TA, Clark MJ, Ash S, Sheppard L. Using staffing ratios for workforce planning: evidence on nine allied health professions. Hum Resour Health 2012; 10 2
| Using staffing ratios for workforce planning: evidence on nine allied health professions.Crossref | GoogleScholarGoogle Scholar |
[8] Campbell L, Bunston R, Colangelo S, Kim D, Nargi J, Hill K, Brooks D. The provision of weekend physiotherapy services in tertiary-care hospitals in Canada. Physiother Can 2010; 62 347–54.
| The provision of weekend physiotherapy services in tertiary-care hospitals in Canada.Crossref | GoogleScholarGoogle Scholar |
[9] Shaw KD, Taylor NF, Brusco NK. Physiotherapy services provided outside of business hours in Australian hospitals: a national survey. Physiother Res Int 2013; 18 115–23.
| Physiotherapy services provided outside of business hours in Australian hospitals: a national survey.Crossref | GoogleScholarGoogle Scholar |
[10] Mudge A, Laracy S, Richter K, Denaro C. Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care. Intern Med J 2006; 36 558–63.
| Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28voslOitA%3D%3D&md5=f2fa1f4fb34e6d27bb5962a1b34eae5cCAS |
[11] English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, Bernhardt J, Crotty M, Esterman A, Segal L, Hillier S. Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data. J Physiother 2016; 62 124–9.
| Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data.Crossref | GoogleScholarGoogle Scholar |
