A seven-day allied health model of care in an acute hospital trauma population: an implementation study.

Abstract

Despite one-third of all trauma admissions occurring over the weekend in Australia, most acute trauma patients only receive allied health input within traditional Monday to Friday service models. This study aimed to determine the acceptability, fidelity and feasibility of a new seven-day allied health model of care within one of Australia's busiest trauma hospitals. An implementation study evaluated the commencement of a new model of care with an additional seven full-time-equivalent, predominantly senior, allied health clinicians over seven days. Acceptability was evaluated through surveys completed by medical, nursing and allied health staff working in the trauma service (n = 151), pre- and post-implementation. Fidelity was evaluated by reviewing referral response time, weekend occasions of service, and at pre-implementation (n = 484 patients), 6-months (n = 456) and 18-months (n = 532) post-implementation. Feasibility was evaluated through practicality and limited efficacy testing (changes in length of stay and Monday discharges) using the Mann-Whitney U or chi-squared tests. Survey results indicated improved accessibility, adequacy, and continuity of staffing. Recruitment and work-life balance were cited as practical challenges. There were significant reductions in referral response times across allied health (from median 17.0 [IQR 6.0- 25.0] hours to median 12.0 [5.0-21.0] hours, p < 0.001), a 53% increase in weekend occasions of service, and although length of stay remained unchanged, the proportion of Monday discharges increased (13% to 18%, p = 0.02). A seven-day allied health trauma service was successfully implemented with outcomes indicating it will be sustainable. Findings are useful for scalability to other hospitals and clinical specialties.