To our knowledge, this is the largest survey to date of WPT service in Canada and the first to target acute-care community hospitals. Our purpose was to review WPT care in community hospitals in terms of availability, patient selection, staffing, workload, scope of services, and availability of other rehabilitation health professions, as well as to document regional differences. We did not attempt to investigate the effects of frequency and intensity of PT service delivery on patient or hospital outcome measures, although this topic needs further investigation.
We found that WPT care was available in almost 70% of acute-care community hospitals across Canada at the time of the survey (January–April 2010). This is a lower proportion than recently found for tertiary-care centres across Canada (97% of 36)16
and is also lower than that found by a survey of Toronto-area hospitals (a mix of hospital types, 26) in the late 1990s (88%).14
Because our response rate was high, this estimate is likely accurate for community hospitals of the type targeted in our survey. We do note some heterogeneity within this group of community hospitals: we observed variation between hospitals in the proportion of hospital beds designated as acute care and found that the availability of WPT care was related to the proportion of acute-care beds.
Our survey uncovered regional variation in the availability of WPT services, particularly between Quebec and the other regions of Canada included in the sample. Only about 30% of community hospitals in Quebec offered WPT services, whereas the region with the next lowest availability (combining Alberta, Saskatchewan, Manitoba, and the Northwest Territories), offered these services at 75% of its sites. It should be noted that there was a lower response rate from Quebec (55% of eligible sites completed the questionnaire, vs. >70% in other regions), which may have affected the results. It is not surprising to find variations between provinces in how services are managed, funded, and/or staffed, since health care services are administered provincially. We note that Quebec has one of the lowest health care spending rates per capita ($4,891).19
However, British Columbia—the next lowest province in terms of per capita health care spending ($5,254)19
—reported the highest regional availability of WPT service in community hospitals. Further investigation into provincial service delivery is required to determine the reasons for regional variation.
We found a lower average number of physiotherapists working on weekend or holiday days (means 1.2–1.6) than previously reported at tertiary sites across Canada (means 2.6–3.0).16
As tertiary-care centres tend to be larger facilities, this difference in staffing may be largely due to a difference in the total number of patients requiring care. The numbers of physiotherapists working on weekend days in this study are comparable to those at community sites sampled by Heck and colleagues,14
where both bed numbers and total number of physiotherapists were smaller than in academic centres. The lower numbers of physiotherapists available on each weekend day at community hospitals may also reflect a smaller number of intensive-care unit (ICU) beds as well as a lower average acuity of patient condition at community hospitals relative to tertiary centres, both of which may lower demand for WPT services, as Heck and colleagues suggested.14
We found that among community hospitals, the most common criteria for referring patients to WPT were acute cardiorespiratory issues, new referrals, and requiring PT to augment or accelerate discharge from hospital. Previous studies of WPT services in tertiary-care hospitals have reported similar referral criteria.6,16
Similar criteria have also been identified in a pooled sample of academic and community hospitals.14
Although the most common criteria are ranked slightly differently by tertiary and community facilities, the indications for WPT service in both facility types cover similar diagnostic categories. As suggested by Campbell and colleagues with respect to tertiary centres,16
criteria used less commonly among community hospitals to refer patients to weekend care may reflect the sub-specialties of particular hospitals and the patient conditions commonly seen in each facility. It is interesting to note that among hospitals not currently offering WPT services, we found varying opinions as to whether particular patient groups (e.g., older adults) required weekend service.
The majority of hospitals that provided WPT service offered time off in lieu during the week as compensation for PT staff working on this service. A survey of Toronto-area hospitals produced similar findings.14
At facilities where weekend care is provided at the expense of weekday care (i.e., therapists away on their “lieu days” are not replaced during the week, and the caseload is spread among the remaining therapists present), overall quality of care may suffer. At facilities where full service is provided 7 days a week, staff schedules and communication tools should be constructed to maximize continuity of patient care.
We believe our survey provides the first description of the availability of other rehabilitation health professional services on weekends and holidays in Canada. Social work was most commonly offered (24% of sites), followed by OT (16%). Our findings differ from those of Hooper and Dijkers,20
who found both OT and SLP to be more commonly available on the weekend (51% and 24%, respectively, on Saturdays and/or Sundays) than SW (14%) in rehabilitation centres in the United States. Several surveyed sites that do not currently offer WPT services reported that a multidisciplinary team would be required to provide effective WPT care. Further investigation into the most appropriate composition of the weekend multidisciplinary team is required.
Our study has several limitations. First, because there is no central, comprehensive list of hospitals and their services in Canada, it is possible that some acute-care community hospitals were not sampled if they were not listed in the 2005 version of the Canadian Health Facilities Directory. However, as we were able to identify hospital closures, mergers, and address changes through mail responses and online information, we do not expect that this would have affected our sampling substantially. Second, we expect that had smaller community hospitals (i.e., with <100 in-patient beds) been included in the survey, the percentage of sites offering WPT care would have been smaller, on the assumption that patients with more serious conditions (and thus more need for high-frequency PT care) would tend to be redirected from these smaller sites to larger, more specialized centres. Given our high response rate, it is likely that we have sampled the majority of facilities within our definition of acute-care community hospitals and that the data presented here are a balanced representation of WPT services in these facilities. Third, because we used a self-report instrument, we were not able to verify the accuracy of participant responses; however, in cases where answers were unclear or incomplete on key issues such as number of beds, number of acute-care beds, and hospital type (community/tertiary), respondents were contacted via e-mail for clarification, if consent for contact had been provided. We were able to obtain all bed numbers, except for the number of acute-care beds in two hospitals, and we were able to obtain hospital types from all respondents.