A weekend acute dysphagia on-call speech pathology service in a regional Australian hospital: impact on patient access, flow, health outcomes and service costs

Objective: Explore the impact of a pilot weekend on-call speech pathology dysphagia service on patient access, flow, health outcomes and service costs in a regional Australian Hospital. Methods: 2,111 retrospective patient records were analyzed for 5-day (August 2019 to January 2020) and 7-day services, comprising 5-day plus weekend on-call (August 2021 to January 2022). Service data was compared between three groupings: Dysphagia(all), acute admission patients coded as dysphagia; Dysphagia(treat), coded dysphagia patients treated by speech pathology; Speech-pathology(treat), all patients receiving speech pathology care. Data included demographic, referral demand, average length of stay, hospital readmission within 28 days, nil-by-mouth, FOIS scores and labour costs. Results: Chi-square tests highlight significant (p < 0.05) increases in speech pathology weekend referrals for dysphagia(all) and dysphagia(treat) groups, with lower dysphagia(treat) Monday referrals. Independent t-tests revealed significant (p < 0.05) reductions in the average length of stay for dysphagia(treat) (20.63%) and speech-pathology(treat) groups (8.06%) for 7-day service. Chi-square reported significantly (p < 0.05) less readmissions within 28 days for speech-pathology(treat) patients in the 7-day service. Independent t-test revealed significantly (p < 0.05) improved dysphagia(treat) 5-day (4.22 vs 5.87) and 7-day (3.60 vs 5.64) FOIS scores. T-tests revealed higher costs ($756,149.99 vs $846,528.87; p = 0.03) and FTE (11.05 vs 12.98; p = 0.01) between the 5-day and 7-day services. Conclusions: The weekend acute dysphagia on-call speech pathology service improved patient access, flow and health outcomes whilst maintaining comparable service costs. The 7-day service provides uniform healthcare flow and patient care. This study also demonstrates the value of weekend service for acute speech pathology patients and highlights positive impacts on regional hospital efficiencies for service optimization.