title: Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services.
abstract: BACKGROUND
  Disinvestment from inefficient or ineffective health services is a growing priority for health care systems. Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision. The relatively high cost of providing this service combined with the paucity of evidence supporting its provision makes this a potential candidate for disinvestment so that resources consumed can be used in other areas. This study aims to determine the effectiveness, cost-effectiveness and safety of the current model of weekend allied health service and a new stakeholder-driven model of weekend allied health service delivery on acute medical and surgical wards compared to having no weekend allied health service.
  
  
  METHODS
  Two stepped wedge, cluster randomised trials of weekend allied health services will be conducted in six acute medical/surgical wards across two public metropolitan hospitals in Melbourne (Australia). Wards have been chosen to participate by management teams at each hospital. The allied health services to be investigated will include physiotherapy, occupational therapy, speech therapy, dietetics, social work and allied health assistants. At baseline, all wards will be receiving weekend allied health services. Study 1 intervention will be the sequential disinvestment (roll-in) of the current weekend allied health service model from each participating ward in monthly intervals and study 2 will be the roll-out of a new stakeholder-driven model of weekend allied health service delivery. The order in which weekend allied health services will be rolled in and out amongst participating wards will be determined randomly. This trial will be conducted in each of the two participating hospitals at a different time interval. Primary outcomes will be length of stay, rate of unplanned hospital readmission within 28 days and rate of adverse events. Secondary outcomes will be number of complaints and compliments, staff absenteeism, and patient discharge destination, satisfaction, and functional independence at discharge.
  
  
  CONCLUSIONS
  This is the world's first application of the recently described non-inferiority (roll-in) stepped wedge trial design, and the largest investigation of the effectiveness of weekend allied health services on acute medical surgical wards to date.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry.
  
  
  BACKGROUND
  ACTRN12613001231730 (first study) and ACTRN12613001361796 (second study). Was this trial prospectively registered?: Yes. Date registered: 8 November 2013 (first study), 12 December 2013 (second study). Anticipated completion: June 2015. Protocol version: 1. Role of trial sponsor: KP and DL are directly employed by one of the trial sponsors, their roles were: KP assisted with overall development of research design and assisted with overall project management; DL contributed to project management, administration and communications strategy.
authors: Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. Terrence.Haines@monash.edu.
authors: Terry P
authors: TP
authors: Haines
authors: Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. Lisa.Obrien@monash.edu.|Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Melbourne, Victoria, Australia. Lisa.Obrien@monash.edu.
authors: Lisa
authors: L
authors: O'Brien
authors: Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. Deb.Mitchell@monashhealth.org.|Allied Health, Monash Health, Melbourne, Victoria, Australia. Deb.Mitchell@monashhealth.org.
authors: Deb
authors: D
authors: Mitchell
authors: Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. Kelly-Ann.Bowles@monash.edu.
authors: Kelly-Ann
authors: KA
authors: Bowles
authors: Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. Romi.Haas@monash.edu.
authors: Romi
authors: R
authors: Haas
authors: Allied Health, Monash Health, Melbourne, Victoria, Australia. Donna.Markham@monashhealth.org.
authors: Donna
authors: D
authors: Markham
authors: Allied Health, Melbourne Health (Royal Melbourne Hospital), Parkville, Melbourne, Victoria, Australia. Samantha.Plumb@mh.org.au.
authors: Samantha
authors: S
authors: Plumb
authors: Physiotherapy Department, Western Health, Footscray, Melbourne, Victoria, Australia. Timothy.Chiu@wh.org.au.
authors: Timothy
authors: T
authors: Chiu
authors: Allied Health, Monash Health, Melbourne, Victoria, Australia. Kerry.May@monashhealth.org.
authors: Kerry
authors: K
authors: May
authors: Health Workforce Branch, Department of Health, Melbourne, Victoria, Australia. Kathleen.Philip@health.vic.gov.au.
authors: Kathleen
authors: K
authors: Philip
authors: Health Workforce Branch, Department of Health, Melbourne, Victoria, Australia. David.Lescai@health.vic.gov.au.
authors: David
authors: D
authors: Lescai
authors: Department of Social Work, Monash Health and Monash University, Melbourne, Victoria, Australia. Fiona.McDermott@monash.edu.
authors: Fiona
authors: F
authors: McDermott
authors: Allied Health, Monash Health, Melbourne, Victoria, Australia. Mitchell.Sarkies@monashhealth.org.
authors: Mitchell
authors: M
authors: Sarkies
authors: Physiotherapy Department, Western Health, Footscray, Melbourne, Victoria, Australia. Marcelle.Ghaly@wh.org.au.
authors: Marcelle
authors: M
authors: Ghaly
authors: Allied Health, Melbourne Health (Royal Melbourne Hospital), Parkville, Melbourne, Victoria, Australia. Leonie.Shaw@mh.org.au.
authors: Leonie
authors: L
authors: Shaw
authors: Allied Health, Melbourne Health (Royal Melbourne Hospital), Parkville, Melbourne, Victoria, Australia. Genevieve.Juj@mh.org.au.
authors: Genevieve
authors: G
authors: Juj
authors: Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. Elizabeth.Skinner@wh.org.au.|Physiotherapy Department, Western Health, Footscray, Melbourne, Victoria, Australia. Elizabeth.Skinner@wh.org.au.
authors: Elizabeth H
authors: EH
authors: Skinner
mesh_terms: D039602:After-Hours Care / Q000191:economics / Q000458:organization & administration*; D000488:Allied Health Personnel / Q000191:economics / Q000458:organization & administration*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D015276:Health Care Rationing / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006302:Health Services Research; D006304:Health Status; D006779:Hospitals, Public; D006801:Humans; D007902:Length of Stay; D017146:Models, Organizational; D009788:Occupational Therapy / Q000191:economics / Q000458:organization & administration*; D010351:Patient Discharge; D010359:Patient Readmission; D017060:Patient Satisfaction; D010561:Personnel Staffing and Scheduling / Q000191:economics / Q000458:organization & administration*; D026741:Physical Therapy Modalities / Q000191:economics / Q000458:organization & administration*; D017064:Process Assessment, Health Care / Q000191:economics / Q000458:organization & administration*; D012107:Research Design; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000191:economics / Q000534:rehabilitation*; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria