• 
• 

Three Part Question

Does a [seven day therapy service] for [patients admitted to an acute medical admissions unit]decrease [length of stay]?

Clinical Scenario

A 78 year old lady is admitted on a saturday follwing a fall at home and acopia. She is then admitted to the acute medical unit. Physiotherapy and Occupation Therapy assessments only occur Monday to Friday between 08:15am and 16:15pm. We wonder whether a seven day therapy service on the acute medical unit would decrease her length of stay.

Search Strategy

PubMed
Cochrane review
Cinahl
Ahmed
Medline
Ovid
Dialog datastar
Pedro
Embase


[(7 day) AND (therapy service OR physiotherapy and occupational therapy OR physiotherapy and OT OR physical therapy and occupational therapy OR physical therapy and OT OR multi-disciplinary team OR MDT service) AND (acute medical admissions unit OR medical assessment unit OR MAU OR observational medical unit OR OMU) AND (length of stay OR time of admission OR length of admission)]

Search Outcome

No articles were initially deemed appropriate and so our search term was expanded to include accident and emergency, ED and A&E
Most of the articles either related to cardiorespiratory working, orthopaedics or rehabilitation and so weren't appropriate.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Vona et al, 2007, Canada	General medical patients	A reterospective chart review pre and post implementation of a seven day a week physiotherapy service on a general medical unit. A total of 344 patient cases were reviewed, 172 patients who received the 5 day a week service and 172 who received the 7 day service.	Length of stay	A decrease in mean length of stay by 2.8 days	The study is only following implementation for a seven day a week physiotherapy service and not joint physiotherapy and Occupational therapy. No mention of whether the GMU has access to an occupation therapy service 5 days a week Only the abstract has been published so information on specific patient groups and physiotherapy received are not included. Which may not be comparable to our service.

Comment(s)

Despite our through initial search and extended search we were unable to locate any clinical papers which matched our three part question. Our search did reveal an abstract which demonasted a decrease length of stay following implementation of a seven day physiotherapy service on a general medical ward. However our three part question relates to a seven day physiotherapy and occupational therapy service. The abstract also gives no information regarding specific patient groups, admission details or the physiotherapy input. Our search has revealed two case reports from UK hospitals who have implemented a seven day a week physiotherapy and occupation therapy service on acute medical units which evidence of a decrease length of stay (see appendix for the attached case reports).

Clinical Bottom Line

There are no clincial research papers available to support our three part question. Although there are case reports which demonstrate a decrease length of stay with a seven day therapy service.

Level of Evidence

Level 2 - Studies considered were neither 1 or 3.

References

1. Vona M The effect of seven day-per-week physiotherapy on length of stay in a general medical unit Physiotherapy Canada May 28 - May31 2009 Pages 53 - 54