Weekend Physiotherapy Practice in Community Hospitals in Canada

Abstract

Purpose: To analyze weekend physiotherapy services in acute-care community hospitals across Canada. Method: Questionnaires were mailed to acutecare community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals. Results: Of 146 community hospitals deemed eligible, 104 (71%) responded. Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: b75% in all regions except Quebec (30%). Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p ¼ 0.021). Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and physiotherapy assistants working (Kruskal-Wallis, p < 0.02 for each). Physiotherapists were predominantly compensated via time off in lieu. Of hospitals not offering weekend physiotherapy, 53% reported that it would benefit patients; most perceived staffing and financial barriers. Social-work services were offered on the weekend at 24% of hospitals and occupational therapy at 16%. Conclusions: Substantial regional variation exists in access to weekend physiotherapy services in acute-care community hospitals. To address the importance of this variation, research on the efficacy and cost-effectiveness of such services is required.Key Words: rehabilitation; hospitals, community; delivery of health care; health services research. RÉ SUMÉObjectif : Analyser les services de physiothé rapie offerts durant les fins de semaine dans les hô pitaux communautaires de soins de courte duré e d'un bout à l'autre du Canada. Mé thode : De janvier à avril 2010, des questionnaires ont é té posté s aux hô pitaux communautaires de soins de courte duré e (é tablissements comptant plus de 100 lits pour hospitalisation, excluant les lits en psychiatrie, en santé mentale, en pé diatrie, en ré adaptation, les soins tertiaires et les é tablissements de soins prolongé s) partout au Canada. Le questionnaire visait à recueillir de l'information sur les critè res justifiant le renvoi en consultation, le personnel, la charge de travail et la ré muné ration pour des services de physiothé rapie offerts les fins de semaine, et sur la disponibilité d'autres professionnels de la santé oeuvrant en ré adaptation. Ré sultats : Des 146 hô pitaux communautaires admissibles, 104 (71 %) ont ré pondu. Des services de physiothé rapie é taient offerts les fins de semaine dans 69 % des hô pitaux au Canada, mais cette proportion varie : b75 % dans toutes les ré gions, sauf au Qué bec (30 %). Il é tait plus probable que des services de physiothé rapie soient offerts les fins de semaine dans les hô pitaux qui disposent d'une forte proportion de li...

Clinicians' Commentary on Ottensmeyer et al.

“…Ottensmeyer and colleagues found that only 69% of such hospitals nationwide offer WPT, with a wide variation from 93% in British Columbia to 30% in Quebec. 1 These percentages are lower than those found in a recent survey of Canadian tertiary hospitals (97% of 36), 2 a difference that could easily be explained by the differing hospital types and the correspondingly different (i.e., lower-acuity) patient populations, as hospitals with a high proportion of acute-care beds were more likely to supply WPT. 1 However, since the authors excluded from their study hospitals that might not be expected to offer WPT (psychiatric hospitals, long-term care facilities, small hospitals with <100 beds, etc.…”

“…Sadly, evidence supporting the value of WPT is still lacking. 1,3,4 There are things we do know, however, such as that bed rest has adverse effects on nearly the whole body, 5 including increased muscle atrophy, decreased cardiopulmonary function, and a decreased level of self-care. 6,7 Even in healthy people, bed rest can induce increased insulin resistance and microvascular dysfunction.…”

“…1 Unfortunately, depending on where you live, the news may not be very good. Ottensmeyer and colleagues found that only 69% of such hospitals nationwide offer WPT, with a wide variation from 93% in British Columbia to 30% in Quebec.…”

“…A median of 14.5 patients per day (range 13.5 to 14.5 patients; difference is reported to be non-significant) were seen on weekends and holidays. 1 Physiotherapists who have worked Saturdays will likely agree that their service is far from overstaffed. But staffing levels are even lower on holidays, with fewer physiotherapists and PTAs working.…”

Does quality of care in hip fracture vary by day of admission?

“…Improving Saturday and Sunday AHP services may facilitate an improvement in quality of care in line with the national care guidelines, as well as yield better patient outcomes [8]. Previous research has shown that the availability of weekend physiotherapy services is variable [20], but that these services have the potential to reduce length of stay and improve functional recovery in hip fracture patients [21]. There is also an association between the intensity and frequency of geriatrician input and improved survival of patients with hip fracture [22][23][24].…”