A seven-day physiotherapy service.

Abstract

Hospitals and primary healthcare services operate around the clock, 7 days a week. Traditionally, physiotherapy services have operated within business hours from Monday to Friday or, if an out-of-hours service has been provided, it has been a reduced service. However, the health problems of some of our patients can deteriorate if not addressed immediately. In addition, many people with less urgent problems may find it difficult to attend physiotherapy appointments during business hours due to their own commitments or work. Consistent with the principles of patient-centred and family-centred care, we have an obligation to provide care for people when they need it and when they are available. This situation, together with the fact that other services and professions in the healthcare system provide care 7 days a week, provides a rationale for a discussion on providing a 7-day physiotherapy service. Some areas of physiotherapy practice have a long tradition of providing services outside of business hours, for example, weekend physiotherapy services for patients with high acuity such as in intensive care units. In the United Kingdom, 97% of intensive care units provide 24-hour access to physiotherapy, and in Canada, 97% of intensive care units haveweekend physiotherapy services. A recent Australian survey found that 80% of acute wards provided physiotherapy on a Saturday. Also, physiotherapists working in private practice, often with a focus on treating musculoskeletal problems, have long provided, at least in Australia, services outside of business hours including weekends. Although we were not able to locate data about the extent of the out-of-hours services provided by private practitioners, information about the number of hours worked by physiotherapists in excess of 40 hours a week suggests that these services may be widespread. In other areas of physiotherapy practice, out-of-hours services are either much reduced or absent. For example, only 30% of rehabilitation services in Australia, and approximately 69% of community hospitals in Canada, provide physiotherapy services at weekends. Although 97% of tertiary care hospitals in Canada provide physiotherapy services at weekends, the service is 88% less than during the week, suggesting that only a skeleton staff is employed to address themost urgent cases. Furthermore, in some centres, night rosters are covered by the most junior staff, who have the least experience at dealing with unexpected or complex changes in a patient’s clinical condition. The case for advocating increased out-of-hours physiotherapy services would be more compelling if its provision was supported by evidence. Such evidence is starting to emerge. A randomised controlled trial from Australia, for example, found that the provision of additional Saturday physiotherapy and occupational therapy helped adults receiving inpatient rehabilitation to get