Weekend speech pathology services in Australian health settings: A cross-sectional survey

Abstract

Purpose

There is limited research on speech-language pathology (SLP) weekend service provision across Australian healthcare services. Therefore, this study aimed to examine weekend SLP services in Australian healthcare services and explore SLP manager perspectives regarding the provision of these services.

Method

A mixedmethods, cross-sectional survey design was employed. SLP managers (or their facility representatives) from Australian healthcare services completed the survey. Quantitative data were analysed using descriptive statistics and qualitative data using qualitative content analysis.

Result

Data from 67 participants were analysed. More than half of the participants’ facilities (n = 39, 58.2%) provided a weekend speech pathology service. Most of these facilities were publicly funded (n = 62, 92.5%) and located in metropolitan areas (n = 41, 61.2%). Nearly two-thirds of facilities employed a dedicated speech-language pathologist for weekend service provision (n = 25/38, 65.8%). Service eligibility criteria were highly variable across sites. More than half (n = 37, 52.2%) of participants predicted a future need for increased weekend SLP services to service subacute wards and to enable access to senior clinicians.

Conclusion

There is variability in weekend SLP service provision, eligibility criteria, and staffing profiles in healthcare facilities around Australia. Further research is required to understand how to inform optimal service delivery models for equitable client care and determine the value of weekend SLP services.

Keywords:

• speech-language pathology
• weekend
• health service models
• survey

Introduction

Health services are under increasing pressure to maximise service efficiency while providing high-value care (O’Brien et al., 2017; Ruiz et al., 2015). Provision of care on weekends is essential to ensuring continuity of care across the 7-day week. Previous research has noted a weekend effect whereby higher rates of mortality, number of adverse events, and increased length of stay have been reported for patients admitted to hospitals on weekends compared with weekdays (Bell & Redelmeier, 2001; Ruiz et al., 2015). Weekend allied health services provide a potential solution to addressing these challenges. Speech-language pathologists are key members of the multidisciplinary allied health team, with skills in the assessment, diagnosis, and management of patients with swallowing and communication impairments. Despite the potential importance of speech-language pathology (SLP) services, there is a lack of existing evidence regarding the provision of weekend SLP services across healthcare services in Australia.

A systematic review by Sarkies et al. (2018) identified positive effects of weekend allied health services on reducing the length of stay in inpatient hospital wards; however, this benefit was evident for subacute wards rather than acute wards. Despite these findings, none of the included studies specifically evaluated the benefits of SLP weekend service provision. One reason for the limited literature may be the inconsistent use and subsequent service models (the way in which healthcare services are delivered) adopted to provide weekend SLP services. In an Australian survey study of allied health weekend service provision in rehabilitation units, Caruana et al. (2018) found that 17% (n = 15/90) of facilities provided weekend SLP services, with only 11% (n = 4/39) providing a Sunday SLP service. SLP assistants were infrequently employed by facilities to support SLP service provision on weekends (8% [n = 7/90] on Saturdays and 8% [n = 3/39] on Sundays; Caruana et al., 2018). In contrast, weekend physiotherapy services were provided in the vast majority (91%, n = 82/90) of rehabilitation units (Caruana et al., 2018). A recent survey study by Davies et al. (2022) explored weekend SLP services for subacute inpatients admitted for stroke in Australia. One-third (34%, n = 20/83) of their sample provided weekend SLP services, with the majority (70%, n = 14/20) in metropolitan areas (Davies et al., 2022). Participants in their study reported prioritising dysphagia assessment and management where relative risk was considered higher, with less than half of respondents (45%, n = 9/20) reporting satisfaction with their provision of weekend SLP services (Davies et al., 2022). While existing studies have profiled SLP weekend service provision, these studies have primarily focused on service provision in inpatient subacute/rehabilitation settings (Caruana et al., 2018; Davies et al., 2022) and/or with stroke populations (Davies et al., 2022). Weekend SLP service provision across Australian healthcare services remains relatively unknown.

Healthcare organisations must justify the provision or non-provision of weekend allied health services, demonstrating the demand for services and benefits to patients associated with increased costs. Allied health managers were interviewed in a study by Mitchell et al. (2017) on the perceived benefits and challenges of weekend allied health services in hospital acute medical and surgical wards in two Australian hospitals. Common benefits reported by participants included improved quality of care, increased patient access to healthcare, and reduced intensive care admissions (Mitchell et al., 2017). However, uncertainty around the evidence to support increased patient outcomes, higher staffing costs, sustainability, and provision of cost-effective models were raised as barriers by participants (Mitchell et al., 2017). The perspectives of weekend allied health staff and associated multidisciplinary team members on the effectiveness of weekend allied health services were sought by O’Brien et al. (2017) in two Australian public hospitals. Positive impacts to patient flow and patient outcomes, enhancing equity of care, and reducing impacts to nursing staff were seen as enablers to the effective provision of weekend allied health services. Allied health staff also reported associated improved workflow, ability to meet care guidelines, and access to patients’ family members on weekends as strong enablers to weekend models (O’Brien et al., 2017). However, high costs to the organisation with poor understanding of cost-benefit, discontinuity of services, duplication of effort, and tendency for inexperienced staff to work weekends were considered barriers to the effective provision of weekend allied health services (O’Brien et al., 2017).

Participants in the study by Caruana et al. (2018) similarly reported that staff availability, budget restraints, and organisational support were the biggest barriers to the implementation of weekend allied health services. Similarly, speech-language pathologist participants in the study by Davies et al. (2022) reported that funding, clinician availability and willingness to work, and clinician experience levels were the most important influences on weekend SLP service provision in subacute settings to stroke inpatients. In the potential absence of these barriers, participants reported weekend SLP services in subacute settings would enable faster response times, improve family/carer satisfaction, and increase therapy intensity (Davies et al., 2022). While these studies have provided valuable insight regarding staff perspectives of weekend allied health services, these have been limited by focusing on the acute public hospital setting (Mitchell et al., 2017; O’Brien et al., 2017), inpatient rehabilitation setting (Caruana et al., 2018), and/or not unpacking the specific enablers and barriers related to weekend SLP service provision (Caruana et al., 2018; O’Brien et al., 2017). A summary of existing evidence related to weekend SLP service provision has been provided in Appendix 1.

Emerging literature has reported on existing models of SLP weekend service delivery in subacute settings (Caruana et al., 2018; Davies et al., 2022) and examined staff perspectives on the provision of allied health weekend service in two acute inpatient hospital settings (Mitchell et al., 2017; O’Brien et al., 2017). There remains a limited understanding of current weekend SLP service provision across healthcare services in Australia. Consequently, health services may find it challenging to determine optimal models of care for weekend SLP service delivery. Healthcare organisations must carefully consider associated benefits and barriers to determine whether their facility would benefit from weekend SLP services. The current research project therefore seeks to examine SLP weekend service provision in Australian healthcare services. Specifically, the aims of this study are to:

1. Investigate the provision and profile of weekend SLP services in health services across Australia.

2. Determine what evidence SLP managers use to inform weekend SLP service models of care.

3. Explore SLP managers’ perspectives on the need for and ideal service models for weekend SLP services.

It is anticipated that this information will enhance understanding of the weekend SLP service models currently employed within Australian healthcare facilities. The findings of this study will also provide insight into how SLP managers make decisions regarding weekend SLP service models and how they can be optimised to inform the allocation or re-allocation of funding for weekend SLP service models, ensuring judicious and equitable use of finite healthcare resources.

Method

Study design

This study used a mixed-methods approach through a customised, web-based survey. The online survey methodology was selected for data collection as it could be easily disseminated and completed by participants across a broad geographical area (Tuten, 2010). The cross-sectional web-based survey (see Supplementary Material 1) was created using Qualtrics XM (2021) software, with the development and implementation based on the principles of health survey design described by Aday and Cornelius (2006). These principles state that the development of survey questions should be guided by similar questions from comparable studies and the survey itself should be evaluated on clarity, balance, and overall length (Aday & Cornelius, 2006). Specific question items were modelled from similar survey studies reporting weekend allied health service provision in the subacute/rehabilitation setting (Caruana et al., 2018; Davies et al., 2022).

The first section of the survey collected general facility demographic information including geographical location, settings of weekend SLP service delivered (e.g. inpatient services), service funding model (i.e. public and/or private healthcare), number of beds at the facility (if it provides inpatient beds), current SLP staffing numbers, and whether the service provided weekend SLP services. In Australia, public healthcare is funded by local, state, and/or federal governments, while private healthcare is funded by a combination of government and private entities (Australian Institute of Health and Welfare, 2022). Public health services are typically funded by the state government and incur no direct costs to the consumer (Nickless et al., 2023a). In contrast, private healthcare includes private hospitals and speech pathology private practices. Notably, there are public funding provisions by the federal Australian government for some independent speech pathology services (i.e. National Disability Insurance Scheme and Medicare; Nickless et al., 2023a, 2023b). Facilities that provided weekend SLP services were asked to outline where these services were provided (e.g. inpatient services in highly acute wards), staffing model and profile, criteria for access (e.g. clinical priority), and what has informed the current model of service provision. A skip-logic sequence (which sent respondents to a future point in the survey dependent on their response to a question) was used to allow participants who did not provide a weekend SLP service to bypass these questions.

All participants were asked to provide their perspectives regarding the influence of the COVID-19 pandemic on weekend SLP services, the potential need for an increase in weekend services, and what the ideal weekend service model would entail. There was a maximum total of 17 question items, presented as a combination of open-ended questions using free-text responses and multiple-choice questions, with some allowing for multiple options to be selected.

Participants and service information

Eligible participants were required to be SLP managers or nominated representatives working in a healthcare service in Australia that provided SLP services to adults. Participants were excluded from the study if they provided services to paediatrics only and/or provided services in private practice. A single representative from each workplace was recruited, to prevent capturing multiple responses from the same facility.

Procedure

The survey was designed by the first author (K.D.) and reviewed by the other three authors (E.F., P.D., K.J.) for content and comprehensibility. Pilot testing was conducted with two final-year SLP students, who provided perspectives based on their clinical experiences but were ineligible to participate as they were not SLP managers or selected representatives. The purpose of pilot testing was to assist with feedback on survey completion time, question flow, and formatting, which informed wording use and the length of the survey. Based on this feedback minor changes were made to the survey, including the addition of a question regarding facility areas with access to weekend SLP services and the expansion of the options from a general “inpatient wards” option, to separate options for “highly acute”, “acute”, and “subacute” inpatient wards. Examples of inpatient wards within each category (e.g. highly acute) were provided (see Supplementary Material 1, Question 8).

Both convenience and snowball sampling were employed in the recruitment of participants, with survey invitations distributed via multiple platforms to maximise the number of participants for the study. Specifically, the survey was distributed through social media (X, formerly Twitter, and Facebook), the Speech Pathology Email ChatS (SPECS) Google Group, the Speech Pathology Australia National eNews, and the professional networks of the research team. SLP managers were encouraged to forward the survey invitation to other eligible colleagues. Thus, estimating the total number of potential participants eligible to complete the survey was not possible. The survey remained open for recruitment for a 3-month period (April to June 2022).

The research was reported in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS; Sharma et al., 2021; see Supplementary Material 2). Ethical approval for this study was obtained from The University of Queensland’s Human Research Ethics Committee (2021/HE002631).

Data analysis

The survey gathered quantitative demographic and service data, as well as descriptive qualitative data regarding participant perspectives. The quantitative data (Questions 1–15) were first imported to Microsoft Excel 2019 to be cleaned and coded. The coded quantitative data were then uploaded to the IBM SPSS Statistics 27 (International Business Machines Corporation, 2020) to generate descriptive statistics, including frequencies and percentages. Reporting of the total number of participants who responded to each question are provided, with valid percentages reported in the associated tables (Tables I and II).

Table I. Participant demographic and service context information.

Characteristic	n (%)
State/Territory (n = 67)
New South Wales	26 (38.8)
Victoria	15 (22.4)
Queensland	13 (19.4)
Western Australia	5 (7.5)
South Australia	4 (6.0)
Northern Territory	2 (3.0)
Tasmania	2 (3.0)
Australian Capital Territory	0
Geographical location of service (n = 64)
Metropolitan	41 (64.0)
Regional	17 (26.6)
Rural/remote	6 (9.4)
Service funding (n = 66)
Public	62 (93.9)
Private	3 (4.5)
Both	1 (1.5)
Setting SLP services offered by facilities on weekdays^a(n = 67)
Inpatient acute	62 (92.5)
Inpatient highly acute	61 (91.0)
Inpatient subacute	53 (79.1)
Outpatients	52 (77.6)
Community	24 (35.8)
Residential	11 (16.4)
	Median (IQR)
Number of inpatient beds (n = 64)	375 (234-600)

Note. Responses are arranged according to percentage frequency, except ^awhere participants were able to select multiple responses; therefore, the percentage does not equal 100. Not all participants provided complete demographic and service context information, therefore, valid percentages are reported. IQR = interquartile range.

Table II. Weekend speech-language pathology service information reported using descriptive statistics.

Characteristic	n (%)
Provision of weekend SLP service (n = 67)
Yes	39 (58.2)
No	28 (41.8)
Setting weekend SLP services delivered^a (n = 38)
Inpatient acute	37 (97.5)
Inpatient highly acute	33 (86.8)
Inpatient subacute	11 (28.9)
Stroke only	2 (5.3)
Paediatric outpatient	1 (2.6)
Weekend SLP staffing model^a (n = 38)
Rostered on-site speech-language pathologist (dedicated position)	25 (65.8)
Rostered on-site speech-language pathologist (additional hours of existing staff/rotated)	15 (39.5)
On-call service	7 (18.4)
Casual staff	4 (10.5)
Rostered on-site AHA working under delegated model	2 (5.3)
Staffing profile of weekend SLP service (n = 37)
Speech-language pathologist only	29 (78.4)
Speech-language pathologist and AHA	8 (21.6)
AHA only	0
Criteria for access to weekend SLP service^a (n = 37)
Clinical priority	24 (64.9)
Reason for referral	20 (54.1)
Ward type	13 (35.1)
Nil criteria	9 (24.3)
Funded service for ward	7 (18.9)
Referral source	3 (8.1)
Variable that has informed current model of weekend SLP service^a (n = 35)
Past provision of SLP services	23 (65.7)
Funding provision to weekend SLP resources	22 (62.9)
Services provided by other hospitals	15 (42.9)
Clinical research recommendations	9 (25.7)

Note. Responses are arranged according to percentage frequency, except ^awhere participants were able to select multiple responses; therefore, the percentage does not equal 100. Not all participants completed service context information, therefore, valid percentages are reported. AHA = allied health assistant.

The qualitative data obtained from the free-text responses (Questions 15–17) were analysed descriptively using qualitative content analysis. Using this approach, categories and subcategories were determined based on participants’ perspectives about the phenomenon rather than existing literature. This analysis process involved re-reading the responses to identify meaning units, labelling the meaning units with a code, and then grouping the codes into categories and subcategories (Graneheim & Lundman, 2004). As per this process, de-contextualisation (Lindgren et al., 2020) occurred whereby participants’ responses to the open-ended component of Question 15 was removed from the quantitative (yes/no) component. The first author (K.D.) coded all qualitative content independently, while the remaining authors (K.J., E.F., P.D.) conducted peer checking to enhance credibility.

Result

Participant demographics

A total of 87 participants visited the survey, all of whom consented to participate. Of those who consented, 20 were excluded for the following reasons: (a) did not respond beyond the consent page (n = 3); (b) provided some facility demographic data, but did not respond to the question regarding whether the facility provided weekend services (n = 7); and (c) facilities were in private practice and/or paediatric clients only (n = 10). The exclusion of these participants resulted in a completion rate of 77%, with a total of 67 participants included in the final data analysis.

Participant demographic and service context information is presented in Table I. Most facilities were located across three east coast states of Australia: New South Wales (n = 26, 38.8%), Victoria (n = 15, 22.4%), and Queensland (n = 13, 19.4%). More than half of the facilities were geographically located in metropolitan areas (n = 41, 64.0%) and a vast majority were publicly funded (n = 62, 93.9%). Services provided were mostly for inpatient care, with 92.5% in acute (n = 62), 91.0% in highly acute (n = 61), and 79.1% in subacute (n = 53). Of the facilities providing inpatient services, the median (range) number of beds was 375 (234–600).

Weekend SLP service provision

More than half of the facilities (n = 39, 58.2%) provided a weekend SLP service (see Table II). Of these 39 facilities, 74.4% (n = 29) were in metropolitan areas and 23.1% (n = 9) were in regional areas. One participant did not specify the geographical location of their facility, while no participants located in a rural/remote area reported providing weekend SLP services. Weekend SLP services were mainly provided to inpatient acute (n = 37/38, 97.4%) and inpatient highly acute wards (n = 33/38, 86.8%). Some facilities offered weekend SLP services to inpatient subacute wards (n = 11/38, 28.9%), and fewer to exclusively stroke care (n = 2/38, 5.3%) and paediatric outpatients (n = 1/38, 2.6%). A range of staffing models were identified, with more than half employing rostered on-site speech-language pathologists in a dedicated position (n = 25/38, 65.8%). Over one-third (n = 15/38, 39.5%) of respondents reported using rostered on-site speech-language pathologists that were rotated amongst team members. Some weekend SLPs were also shown to be employed using on-call staffing profiles (n = 7/38, 18.4%), with a small number employed on a casual basis (n = 4/38, 10.5%). The most common staffing profile on weekends involved speech-language pathologists only (n = 29/37, 78.4%), while the remaining facilities employed an allied health assistant in addition to a speech-language pathologist (n = 8/37, 21.6%).

Three main criteria for access to weekend SLP services were clinical prioritisation (n = 24/37, 64.9%), reason for referral (e.g. new stroke; n = 20/37, 54.1%), and ward type (e.g. acute ward; n = 13/37, 35.1%), while nine (24.3%) of the participants’ facilities had no specified criteria for accessing weekend SLP services. More than half (59.5%, n = 22/37) of participants’ facilities considered more than one criterion for determining eligibility for weekend SLP service provision (e.g. clinical priority and reason for referral). Most participants reported their current weekend service had been informed by a combination of past provision of SLP services (n = 23/35, 65.7%) and funding models (n = 22/35, 62.9%), while one quarter indicated clinical research recommendations influenced their service (n = 9/35, 25.7%).

Impact of COVID-19 on weekend SLP services

Participants who provided a weekend SLP service were asked to explain the impact of COVID-19 on their services. Nearly three-quarters (n = 26/36, 72.3%) of participants reported no associated changes to weekend SLP service provision. A further 22.2% (n = 8/36) of participants reported increased weekend SLP service provision. The remaining participant (n = 1/36, 2.8%), who was based in a metropolitan area, reported a reduction in services.

Facilities’ needs and plans for weekend SLP services

Participants were asked to outline their facilities’ needs and plans for weekend SLP service. Responses were provided by 92.5% (n = 62/67) of participants for this question. More than half (n = 37/62, 59.7%) of these participants identified a need to request additional SLP staffing resources at their facility, while the remaining participants did not see a need to request or increase weekend SLP services on weekends (n = 25/62, 40.3%). Four categories were generated from participants related to their reasoning for identifying or not identifying a need to request an increase in weekend SLP services including (a) enhancing service capacity to meet demand, (b) maintaining existing service, (c) barriers to weekend service provision, and (d) benefits of weekend SLP services (see Table III). The following section outlines these categories, their subcategories, and examples provided by participants.

Table III. Facilities’ plans for weekend speech-language pathology services analysed using qualitative content analysis.

Category	Subcategory	Example response
Enhancing service capacity to meet demand	Increased service demand (n = 14)	“The weekend service has grown about 30% in last 5 years and has reached capacity.” (P41)
	Inequitable access across caseloads/service areas (n = 4)	“This service is currently funded for stroke service only, however significant need for service across all caseloads and ICU [intensive care unit].” (P3)
	Temporary COVID-19 surge funding (n = 3)	“Currently using COVID related funding to provide an adhoc weekend service to support discharges and bed flow.” (P17)
	Need for specific services (n = 3)	“Dysphagia and stroke services.” (P1)
	Risk mitigation (n = 1)	“Inappropriate oral plans made over the weekend.” (P44)
	Funding submissions (n = 2)	“Briefing note now to request substantive funding.” (P25)
Maintaining existing service	Insufficient demand for weekend SLP services (n = 10)	“Small stable population, real emergencies go to the regional hospital, all others are NBM [nil by mouth] until assessed.” (P51)
	Satisfied with current weekend SLP service (n = 4)	“We have recently received additional funding for our stroke and trauma patients on the weekend. We’re now well staffed with 3 part day weekend shifts each Saturday and Sunday.” (P67)
Barriers to weekend service provision	Workforce challenges (n = 6)	“Not feasible to continue long term with small department and rostering on-call using weekday staff. Risk of burn out.” (P12)
	Lack of funding (n = 6)	“There’s no pont [sic]- we need more, they complain to us for more, but when it comes to actually funding it – SILENCE.” (P38)
	Denial of previous requests (n = 3)	“We have tried this in the past, and it was not approved.” (P7)
	Use of existing resources (n = 1)	“We’re advised we can have an ongoing weekend service if we 'pull’ from weekday eft [equivalent full-time] (stretch existing eft across 6 or 7 days) which I strongly feel is not a satisfactory solution/is not patient centred.” (P16)
	Lack of data to inform value (n = 2)	“A challenge has been how to provide weekend services add value (reduce length of stay > reduce cost to health service).” (P16)
	Organisational expectations (n = 1)	“Expectation for 24/7 service” (P15)
Benefits of weekend SLP services	Patient care and outcomes (n = 4)	“We know it supports patient care by minimising time patients spend NBM, awaiting SLP assessment for dysphagia related diet/fluid upgrade/downgrade, communication support etc.” (P16)
	Resources (n = 1)	“If they fail the ASSIST [Acute Screening of Swallow in Stroke/Transient Ischaemic Attacks] they remain NBM until SLP service return during the week - resulting in unnecessary NGTs [nasogastric tubes] (waste of radiology and consumable resources, discomfort, aspiration risk).” (P17)
	Patient flow and discharge (n = 3)	“Significant need for service across all caseloads and ICU to assist with delivering comprehensive care and assisting with hospital flow and discharge planning.” (P3)

Category A: Enhancing service capacity to meet demand

More than half of the participants predicted a need for increased weekend SLP services at their facility. Six subcategories were generated within this category including: (a) increased service demand, (b) inequitable access across caseloads/service areas, (c) temporary COVID-19 surge funding, (d) need for specific services, (e) risk mitigation, and (f) funding submissions. Primarily, participants indicated a need to support increased weekday demand with one participant explaining, “the acuity of hospital admissions has increased and there is limited capacity to manage the current referrals and respond to NSF [National Stroke Foundation] guidelines with the current limited FTE [full-time equivalent]” (P32). Participants also described the need to provide weekend SLP services across more clinical areas, with one participant stating: “currently inequitable service provided, i.e. only acute strokes who have failed ASSIST [Acute Screening of Swallowing in Stroke/Transient Ischaemic Attacks tool] and all other referrals placed on the weekend in need of SLP services have to wait until the weekday service” (P12).

Category B: Maintaining existing service

Many participants discussed the need to maintain existing service provision, with two primary subcategories generated: (a) insufficient demand for weekend SLP services and (b) satisfaction within current weekend SLP service. Ten participants indicated that there was insufficient demand for a weekend SLP service, with one participant stating, “the acuity of our patients does not warrant a weekend service, nor do the number of presentations” (P48). Another participant further explained that the “volume of inpatient referrals [is] not high enough, if patients are very acute [they are] more likely flown out by RFDS [Royal Flying Doctor Service] prior [to SLP review]” (P28). Notably, these participants were all located either regionally or rurally. In contrast, other participants (n = 4) were satisfied that their weekend SLP service met the existing demands of their service, stating that no further changes to the service were needed. Two participants revealed this viewpoint was due to a recent staffing increase.

Category C: Barriers to weekend service provision

Numerous barriers were reported by participants to weekend SLP service provision related to the following subcategories: (a) workforce challenges, (b) lack of funding, (c) previously denied requests, (d) use of existing resources, (e) lack of data to inform value, and (f) organisational expectations. Regarding workforce challenges, P16 explained, “we’re advised we can have an ongoing weekend service if we “pull” from weekday EFT [equivalent full time] … which I strongly feel is not a satisfactory solution/is not patient-centred.” Meanwhile, P55 stated that requests for weekend SLP services have, “been denied on multiple occasions.” Another participant expressed challenges associated with funding, "we currently do not have a permanent [SLP] weekend service funded. It is completely reliant on the COVID surge funding at present” (P18).

Category D: Benefits of weekend SLP services

The benefits of weekend SLP services were reported by some participants when considering their future needs. These benefits are related to three subcategories including: (a) patient care and outcomes, (b) resources, and (c) patient flow and discharge. Participants frequently discussed the benefits of reducing time patients spent nil by mouth (NBM) and enabling opportunities to enhance rehabilitation, with P30 suggesting the following service opportunities on weekends, “NBM patients awaiting SLP assessment (including those who fail the DST [Dysphagia Screening Tool]), dysphagia rehab (those requiring intensive service), complex dysphagia (with high-risk aspiration, close monitoring required).”

Participants’ perceptions on ideal weekend SLP services

Participants were asked to describe their ideal weekend SLP services. Most (n = 57/67, 85.1%) participants responded to this question, describing their ideal weekend SLP service related to five categories (see Table IV). These categories included: (a) clinical focus, (b) service models and priorities, (c) shift patterns, (d) professional governance, and (e) no weekend service. The following section briefly describes and outlines these categories, their subcategories, and examples provided by participants.

Table IV. Perceptions of ideal weekend speech-language pathology services analysed using qualitative content analysis.

Category	Subcategory	Example response
Clinical focus	Subacute/rehabilitation care (n = 6)	“Including more than cat [category] 1 patients, including access to early supported rehab.” (P17)
	Facility-wide service (n = 1)	“Whole of hospital.” (P3)
	Access to instrumental assessment and specialist services (n = 2)	“Access to radiology for VFSS [videofluoroscopic swallowing study] and access to SLP/ENT [Ear, Nose and Throat] scoping for FEES [fiberoptic endoscopic evaluation of swallowing]” (P13)
	High priority patients (n = 2)	“Patients with high priority for communication assessment or support are serviced, involvement in ICU cuff deflations/speaking valve trials to promote earlier decannulation.” (P53)
Service models and priorities	Comparable weekend to weekday service (n = 5)	“Mirror weekday services in terms of access and service provided.” (P42)
	Operational focus (n = 2)	“Ideally, the service would adhere to patient quality and safety standards, support operations of the health service (i.e. flow, discharges), and be one that’s economically, efficient.” (P40)
	Student models (n = 1)	“Options for student placements over weekend.” (P13)
	Additional full-time equivalent (n = 1)	“I would need additional FTE and a person who wanted to work every weekend.” (P22)
Shift patterns	On-call (n = 7)	“On call for triage via phone then potentially telehealth if needed.” (P28)
	Rotational (n = 3)	“I think rotational weekend services work best for staff morale and wellbeing, however this is not always possible depending on staff availability, FTE worked and skill mix.” (P19)
	Specified service days and hours (n = 36)	“4hr set shifts for both Sat & Sun, Public Holidays” (P35)
Professional governance	Access to senior SLP staff (n = 5)	“Senior onsite to support and work with junior staff.” (P41)
	Team support (n = 3)	“We need to have someone rostered on Sat and Sun for a minimum of 6 hrs plus a minimum of a weekday shift to allow for handover, team inclusion and governance (supervision, mandatory training access etc).” (P37)
No weekend service	Service not required (n = 1)	“Not currently needed.” (P65)

Category A: Clinical focus

Participants described clinical areas that a weekend SLP service should focus on for service provision. Four subcategories were generated within this category including: (a) subacute/rehabilitation care, (b) facility-wide service, (c) access to instrumental assessment and specialist services, and (d) high priority patients. Service provision to subacute/rehabilitation wards was reported by a number of participants as a feature of an ideal weekend SLP service. P25 indicated this service would include, “access to early supported rehab.” Participants also reported that weekend SLP services which included instrumental swallowing assessment would be advantageous to weekend SLP service provision. Facility-wide service provision was mentioned by one participant (P3) to ensure that the weekend SLP service was available for all admitted patients in the hospital rather than particular areas only. In contrast, some participants felt that only high priority patients should be serviced as part of an ideal weekend SLP service. P52 explained their rationale for this viewpoint as, “this would help with fatigue mgmt [management] for rostered staff who then work 7 days Sat-Fri.”

Category B: Service models and priorities

Participants reported four subcategories related to the overarching category of service models and priorities. These subcategories included: (a) comparable weekend to weekday service, (b) operational focus, (c) student models, and (d) additional FTE. Many participants expressed a desire to see the same service across the 7 day week, with P4 stating this service would, “ideally [be] a 7 day service that includes acute and rehab cover.” P3 indicated that weekend SLP services, “could be operational priorities/discharge/flow based.” Meanwhile, another participant (P13) suggested student models as an option to help manage weekend SLP service demand, while additional FTE was suggested by P22 as essential for the provision of ideal weekend SLP services.

Category C: Shift patterns

Three subcategories relating to the category of shift patterns were generated: (a) specific service days and hours, (b) on-call, and (c) rotational. The vast majority of participants specified specific service days and hours when providing their perspectives of ideal weekend SLP services. Participants had clear opinions, with most describing that 4 hour shift patterns would provide sufficient service cover. Six or 8 hour shift patterns were also commonly suggested. P12 stated that, “for our site it would be 4 hours each sat and sun with a designated position that crossed over either side of the weekend days for 8 hours each day to maximise continuity of care and ensure adequate governance and team involvement.” On-call models were another option that participants felt would characterise their facility’s ideal weekend SLP service, with P24 stating: “on call for 4-6 hours Sat & Sun, with recall as needed.” Fewer participants believed rotational staffing on the weekends would meet their service needs; however, P19 explained that these models, “work best for staff morale and wellbeing”, while also acknowledging, “this is not always possible depending on staff availability, FTE worked and skill mix” (P19).

Category D: Professional governance

Participants described professional governance considerations related to two subcategories: (a) access to senior SLP staff and (b) team support. Participants indicated that weekend SLP services should be staffed by a senior SLP or have access to either an on-site or on-call senior speech-language pathologist, particularly to assist with complex caseloads. P26 stated that, “HP4 [Health Practitioner Level 4] - specialist service eg trache [tracheostomy] management, HP3 for acute priority ward assessments.” Participants also discussed the need for professional governance by stating that speech-language pathologists providing weekend services should also work on weekdays to “ensure adequate governance and team involvement” (P12).

Category E: No weekend service

One participant (P65) indicated that weekend SLP services were not required in their facility, and thus, no ideal weekend SLP service was reported.

Participants’ additional comments on weekend SLP services

Participants were asked to provide any additional comments related to weekend SLP services. Approximately half (n = 34/67, 50.7%) of participants provided further comments. Four categories were generated (see Table V) from this question: (a) challenges, (b) benefits, (c) service considerations, and (d) workforce considerations. The following section outlines these categories, their subcategories, and examples provided by participants.

Table V. Participants’ additional comments on weekend speech-language pathology services were analysed using qualitative content analysis.

Category	Subcategory	Example response
Challenges	Speech-language pathologist attraction and willingness to work (n = 10)	“We are finding it increasingly difficult to find speech pathologists wanting to work during the week. If I did magically have someone willing to work on a weekend I couldn’t guarantee that this would be an arrangement that would continue.” (P22)
	Funding issues (n = 4)	“We are the only metropolitan hospital who is not currently funded to have a weekend Speech Pathology service. It is a service which would benefit our community immensely.” (P18)
	Prioritisation of services (n = 2)	“Subacute is always left out, the first deprioritised – but we can also make a big difference here” (P38)
	Regional and rural/remote contexts (n = 4)	“I used to provide on-call weekend services in a previous role at a private hospital in a regional site and it fluctuated with referrals for weekend cover.” (P28)
Benefits	Staff benefits (n = 1)	“Redcued [sic] caseload/stress for weekday staff, reduce stress levels of weekend Nursing and medical teams” (P20)
	Patient benefits (n = 5)	“Better patient care (less time being NBM), Quicker d/c [discharge] movement through the system” (P20)
	Personal/professional benefits (n = 1)	“It has been a great opportunity to up-skill in new areas, problem solve and work independently. I am very grateful for the position” (P61)
Service considerations	Specific service models (n = 2)	“Potentially 3 hr shift Sat/maybe Sunday for rehab patients and then on-call acute for new referrals.” (P44)
	Meeting service demands and expectations (n = 2)	“It is important for the advocacy of SLP services that we respond to the emergent needs of the facility which is to provide a 7 day/week service.” (P32)
	Service not required (n = 1)	“Our service is still currently too small to support a weekend service model.” (P24)
	Consistency with multidisciplinary team (n = 1)	“Other Allied Health professions e.g. Physio [physiotherapy] and OT [occupational therapy] already have weekend services.” (P10)
	Value-based care (n = 2)	“Need to consider whether services are high value over a weekend period.” (P34)
	Use of evidence and data (n = 2)	“It would be great to have evidence re: weekend speech pathology services, particularly for regional areas. Data and information re: flexible options for weekend service with small departments would also be wonderful.” (P14)
Workforce considerations	Workforce strategies (n = 4)	“Second year new grad [graduate] roles being allocated weekend roster for 1 year and creation of dedicated weekend senior position, promoting penalty rates and additional two weeks AL [annual leave] per year etc.” (P41)
	Team connection (n = 1)	“Also, you wouldn’t want someone working only on the weekend without any connection to the broader team. This would bring risks with it.” (P22)
	Need for senior staff (n = 2)	“We are a tertiary hospital with large specialty caseload therefore need a senior on weekend.” (P55)

Category A: Challenges

Participants described key challenges related to weekend SLP service provision, related to four subcategories: (a) speech-language pathologist attraction and willingness to work, (b) funding issues, (c) gaps in service provision, and (d) regional and rural/remote contexts. Managers frequently reported workforce challenges involving recruitment and willingness of speech-language pathologists to work on weekend shifts, particularly in regional areas, with P7 explaining, “as we are a small team, buy in from the current team has been mixed.” Funding of weekend SLP services was also a challenge reported by several participants, with P45 explaining, “our budget currently does not allow for weekend cover.” Gaps in service provision whereby weekend SLP services did not manage patients across the facility were also identified. For instance, P8 stated: “although the hospital has adult and paediatric patients we do not provide any paediatric weekend services.” The service contexts in regional and rural/remote contexts were also highlighted as an additional challenge, with P43 reporting: “this is a challenging model in a regional area due to limited availability of casual and part-time staff with the right skill mix.”

Category B: Benefits

Participants reported benefits of weekend SLP services related to three subcategories: (a) staff benefits, (b) patient benefits, and (c) personal/professional benefits. Benefits to patients were described by multiple participants, including P64 who indicated that weekend SLP services “should be mainstream practice to ensure timely and equitable access to SLP services for all patients.” Benefits to staff as a result of weekend SLP services were reported, with P11 stating that: “our Sunday service has reduced the workload for weekday staff on Mondays.” One participant (P61) suggested both personal and professional benefits to working in a weekend SLP service: “it has been a great opportunity to up-skill in new areas, problem solve and work independently. I am very grateful for the position.”

Category C: Service considerations

Six subcategories related to the overarching category of service considerations were reported by participants. These subcategories included: (a) shift length, (b) meeting service demands and expectations, (c) service not required, (d) consistency with multidisciplinary team, (e) value-based care, and (f) use of evidence and data. In relation to the subcategory of shift length, P61 indicated that, “I am very grateful for the position however I think that it would benefit from longer hours with clearer guidelines - it may improve the longevity of speechies [speech-language pathologists] in the role.” Participants also described service considerations related to the subcategory meeting service demands and expectations, with P5 stating that weekend SLP service provision “is an essential component of our work.” In relation to the subcategory of service not required, one participant (P24) indicated that the size of their service did not warrant a weekend SLP service. Meanwhile, another participant (P10) stated that their lack of weekend SLP services was inconsistent with other allied health disciplines where a weekend service was being provided (related to the subcategory consistency with multidisciplinary team).

P40 encapsulated both the value-based care and the use of evidence and data subcategories respectively by explaining, “sites setting up and continuing weekend services … [need to determine] priorities relating to value-based healthcare…”

and

…services need to ask questions such as a) is this service optimising quality and safety of patient care; b) is this service facilitating broader organisational visions/strategies/operations (i.e. supporting care closer to home; optimising patient flow; supporting discharges) and c) is this service economically efficient to run?

Category D: Workforce considerations

Participants commented on workforce considerations related to three subcategories: (a) workforce strategies, (b) team connection, and (c) the need for senior staff. Related to the subcategory of workforce strategies, participants highlighted strategies that enabled successful weekend SLP service provision including P21 who stated, “rotational is a must for work-life balance, unless the contract actually says they are employed as a weekend SP [speech-language pathologist].” P22 outlined the importance of team connection during the weekday due to potential risks associated with speech-language pathologists working only on weekends. Participants also discussed the need for senior SLP involvement in weekend SLP service provision (related to subcategory of need for senior staff), with P5 commenting that the speech-language pathologist “needs to be more than base grade clinician ideally.”

Discussion

This study explored weekend SLP service provision within Australian healthcare facilities and SLP manager perspectives on these services. While previous studies have provided demographic information about weekend SLP service provision, these were specific to inpatient subacute care facilities and/or stroke service provision (Caruana et al., 2018; Davies et al., 2022). Our findings revealed that weekend SLP services were provided in more than half (n = 39, 58.2%) of the surveyed health facilities across Australia. Most of these facilities were in metropolitan areas rather than regional or rural areas, due to the demand with increased patient acuity, referral numbers, and access to resources. Our study is the first to report on weekend SLP models of care employed by health facilities in Australia, demonstrating high variation in service access, staffing types, and experience levels. Additionally, this study has revealed diverse perspectives on the needs for weekend SLP services, with workforce and organisational barriers and enablers to their success. These findings are in keeping with existing studies related to weekend service provision that describe substantial variation in the delivery of weekend allied health services (Mitchell et al., 2017), tension between the benefits to patients and evidence supporting these models (Davies et al., 2022; Mitchell et al., 2017; O’Brien et al., 2017), workforce attraction to these roles (Davies et al., 2022), and financial considerations (Caruana et al., 2018; Davies et al., 2022; Mitchell et al., 2017; O’Brien et al., 2017).

Staffing models described by participants in this study were variable, including rostered on-site speech-language pathologists in dedicated weekend roles, rotational rosters amongst existing SLP staff, on-call models, and use of AHAs. Rostered on-site speech-language pathologists were identified as the dominant staffing profile used on weekends. Despite this, some participants reported that alternative staffing models, such as rotational rosters, would be optimal in their facility to support staff wellbeing. Consistent weekend rostering has been found to contribute to high turnover in nursing staff (Shader et al., 2001; Strachota et al., 2003). Davies et al. (2022) similarly identified that clinician willingness was a key barrier to the provision of weekend SLP services in subacute settings. Mitchell et al. (2017) and O’Brien et al. (2017) also identified challenges broadly within allied health related to staffing and determining optimal rostering models for weekend service provision. Reduced clinician willingness to work on weekends suggests that SLP managers may need to consider alternative models such as rotational rosters, access to senior speech-language pathologists for support, or incentives to attract staff to these positions. Rotational rostering models may enhance equitability in weekend SLP staffing and promote staff morale. However, clinician availability and appropriate skill set will remain challenges to applying this, particularly whereby small SLP teams exist, which was also acknowledged by participants in our study.

The most common criteria for accessing weekend SLP services included clinical priority and reason for referral. However, a lack of equity of service provision across caseloads was reported by participants who indicated that when weekend speech-language pathologists worked through a clinical priority hierarchy, often only acute and highly acute inpatients were able to be seen¹. Participants reported that many of these referrals would be for initial swallow assessments of acute stroke patients. The provision of timely swallowing assessment and management supports adherence to the Stroke Foundation Clinical Guidelines (Stroke Foundation, 2022) and care to this clinical caseload. However, patients within subacute wards were reported to often be deprioritised on weekends, as they were not considered a priority for the limited weekend SLP service available. While participants believed that the provision of subacute care was not critical for reducing potentially adverse medical outcomes, it was an area in which SLPs could demonstrate substantial benefits for patients and the healthcare system.

In a systematic review investigating the provision of weekend allied health services, including SLP, Sarkies et al. (2018) identified better evidence related to reductions in length of stay for allied health service provision within subacute wards (2.35 day reduction) than acute and surgical wards. However, these studies likely have limited applicability to informing the effectiveness and cost-effectiveness of SLP weekend service models². Two studies (Haas et al., 2018; Haines et al., 2017) in this systematic review included allied health weekend services whereby speech-language pathology was one of the disciplines included in the evaluation. Specifically, the study by Haines et al. (2017) examined the effect of weekend allied health services on acute inpatient hospital wards, with outcome measures including length of stay, re-admission rates, adverse events, discharge to aged-care facilities, and costs to the healthcare system (Haines et al., 2017). The study by Haas et al. (2018) cited in Sarkies et al. (2018) was unable to be located. However, a study by the same authors with a similar title (Haas et al., 2018) specifically explored the effect of an acute weekend physiotherapy service in an orthopaedic ward to patients with lower limb joint replacements, with no reference to SLP weekend services.

Provision of rehabilitation to improve clinical outcomes, along with family education and training, are key interventions that enable patients and families as they transition beyond the hospital environment upon discharge. Participants in studies by Davies et al. (2022) and O’Brien et al. (2017) noted increased access to family and carers as a benefit of weekend services, allowing for comprehensive discussions and information sharing. Increased access to family members would allow speech-language pathologists to effectively utilise weekend service provision, to contribute to improved patient satisfaction and person-centred care. In determination of high-value care, SLP managers may be better able to determine value as a measure of service model effectiveness as an alternative to existing priority-based systems if resources are directed towards subacute care.³

Participants in our study were SLP managers (or their nominated representativess) who were well placed to provide insights into the associated workforce, and operational and service-level barriers to weekend SLP service provision in Australian healthcare services. A key barrier influencing weekend SLP service provision was a lack of funding. Healthcare services remain under constant strain to justify the use of resources within fiscally constrained environments. Participants in metropolitan areas reported increased patient acuity and referral numbers over time, resulting in increased demand for SLP services. Despite this, commensurate increases in funding for weekend speech-language pathologists had not been provided to support service provision. Participants also reported the need to present justifications for SLP services with evidence of improved bed flow and increased discharges over the weekend, rather than considering other metrics in the provision of high-value care. However, the key influencing factor for their current weekend SLP service was past service provision and funding, rather than clinical research recommendations. Weekend SLP services have typically prioritised resources towards acute risk management (i.e. dysphagia assessment), which may not easily lend itself to tangible outcomes demonstrating reductions in length of stay and cost-effectiveness. In the study by Mitchell et al. (2017), allied health managers stated that delays to patients accessing allied health services were known to lead to negative or less-desirable patient outcomes; however, they reported uncertainty in determining if the overall benefits to patients and the healthcare system justified the costs of weekend services.

O’Brien et al. (2017) argue that for weekend allied health services to be effective and cost-effective, the right patients need to receive appropriate interventions at the right time, as insufficient investment in allied health resources does not generate benefits to patient care. Thus the focus on acute dysphagia risk mitigation, rather than the provision of dysphagia and communication rehabilitation or facilitation of discharge planning, should be challenged. Service provision with demonstrated impacts on bed flow and length of stay may contribute to increased success in obtaining funding for weekend SLP services and have concomitant impacts on attraction to speech-language pathologists who contribute. However, the gap between research and anecdotal evidence of benefit also demonstrates a gap in the translation of research findings related to the value of SLP services. While reliance on clinical experience makes it highly difficult to justify weekend SLP services on health expenditure in relation to the benefits for patients and the healthcare system, SLP managers and health organisations should consider all four components of evidence-based practice, i.e. best research evidence, clinical expertise, the patient, and the practice context (Hoffman et al., 2016; Straus et al., 2011), when determining value and the evidence related to weekend SLP service provision.

The impact of the COVID-19 pandemic on the Australian healthcare system is an important consideration when discussing factors that influence health service provision. While most of our participants reported COVID-19 had not changed the nature of their weekend SLP service, several Victorian participants identified the need for increased weekend SLP services to support demand. Victoria was one of the Australian states most impacted by COVID-19 and thus increased demand is unsurprising. Some Victorian participants reported additional temporary funding in the way of Hospital Surge Support Allowance in 2021 (Victorian Government, 2022) to manage this demand; however, they stated that increased service demand remained following the cessation of this funding support.

Limitations

Several limitations related to the design and recruitment strategy for this study were apparent. The sample size of 67 participants meant that only descriptive analysis could be performed on quantitative data, which limited the ability to make inferences from the data. However, participants provided rich qualitative data in outlining needs, benefits, and challenges to weekend SLP service models, which can be considered for SLP managers within their practice contexts. The sampling strategies used for participant recruitment meant that the overall number of potentially eligible SLP managers and the services they represented were unknown. Most of the participants were from public services, and therefore it may be difficult to extrapolate the findings of this study to private contexts.

The survey design was limited by not forcing a response to all questions, resulting in several incomplete responses and missing data. The missing data had to be removed from the dataset and ultimately reduced the number of responses included in the analysis. Data capture was also limited for the question related to staffing /full-time equivalent (FTE), as participant responses were inconsistent and not congruent with weekend equivalent expectations (e.g. 5 days a week or 2.4), leading to an inability to reliably interpret and analyse this datapoint. Further, participants were asked to self-select their geographical location (e.g. metropolitan), rather than provided with clear definitions to ensure consistent interpretation. Similarly, participants were not provided with a clear definition of public or private funding. Obtaining the views of SLP managers exclusively could also be considered a limitation of this study. Future studies would benefit from a larger sample, and seek patient and organisation (e.g. executive management) perspectives on weekend SLP service provision.

Conclusion

This study identified varying presence and models employed for weekend SLP service provision in Australian health facilities. Most of the participants worked in publicly funded facilities, were in metropolitan areas, and used a rostered speech-language pathologist in a dedicated weekend position. Many participants also supported a need for increased weekend SLP services and expressed a need to see more equitable 7 day service models employed. Participants who did not predict a need for increased services were commonly located in regional and rural locations, for which there was insufficient demand and greater difficulties related to staffing attraction to these roles. Future research should investigate the differences in service contexts of facilities that are located regionally and rurally to provide more evidence for optimal service models, including how to recruit and retain speech-language pathologists for these positions. Additionally, further research should also be directed to determining optimal weekend service models across healthcare settings, informed by key stakeholders (e.g. patients, healthcare professionals, executive management, and funders) with associated cost-benefit analyses. The identification of optimal weekend service models will also ensure the provision of high-value care.

Acknowledgements

The authors would like to thank the participants who contributed to this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Equity is defined as per Raine et al. (2016, p. 72-73): “both a horizontal version (people with equal needs should be treated the same) and a vertical version [people with greater clinical needs should have more intervention (provided it is effective) than those with lesser needs (unequal use for unequal need)].”

2 Effective refers to “ability to achieve intended outcomes” and cost-effective refers to “most efficient and least expensive” as defined by O’Brien et al. (2017, p. 2).

3 Value-based healthcare is defined as per Queensland Health (2022): “value-based health care (VBHC) is an evidence based, person-centred approach to support health care decision making and system transformation, with the aim of improving both health outcomes and the experience of care across a full care pathway for people, service providers, communities, health professionals and populations.”

Appendix 1. Summary table of existing evidence related to weekend SLP services.

  

  

Table

Citation	Aim/s	Study design + participants	Clinical population, settings + location	Key findings/outcomes
Caruana et al. (2018)	Exploring current service provision, staffing, perceived outcomes, and barriers and facilitators to weekend service provision.	Study design: Cross-sectional survey Participants (n = 214): Senior physiotherapists responded on behalf of rehabilitation unit.	Dedicated rehabilitation units at state and private hospitals Australia	17% (n = 15/90) of facilities provided weekend SLP services SLP assistants were infrequently employed by facilities to support SLP service provision on weekends. Barriers were staff availability, budget restraints, and organisational support
Davies et al. (2021)	Investigate the provision of an Australian SLP weekend service to subacute stroke inpatients. Explore speech-language pathologists’ perceptions about the role of this service.	Study design: Cross-sectional survey Participants (n = 83): SLPs working in subacute inpatient units that provided a weekend SLP service.	Stroke population Publicly and/or privately funded subacute adult inpatient rehabilitation facilities Australia	One-third (34%, n = 20/83) of their sample provided weekend SLP services, with the majority (70, n = 14/20) in metropolitan areas. prioritising dysphagia assessment and management where relative risk was considered higher, with less than half of respondents (45%, n = 9/20) reporting satisfaction with their provision of weekend SLP services enable faster response times, improve family/carer satisfaction, and increase therapy intensity Barriers were funding, clinician availability and willingness to work, and clinician experience levels
Mitchell et al. (2017)	In-depth investigation of the challenges and uncertainties faced, and the benefits perceived by allied health managers in designing and providing weekend allied health services on twelve acute medical and surgical wards.	Study design: Interviews undertaken during a multi-site stepped wedge randomised controlled trial Participants (n = 22): Allied health managers responsible for managing weekend services.	Hospital acute medical + surgical inpatient wards (n = 12) in two Australian hospitals	Participants reported improved quality of care, increased patient access to healthcare, and reduced intensive care admissions uncertainty around the evidence to support increased patient outcomes, higher staffing costs, sustainability, and provision of cost-effective models
O’Brien et al. (2017)	Identify factors that might enable an effective and cost-effective weekend allied health services on acute hospital wards.	Study design: Focus groups within acute wards with a weekend allied health service and telephone interviews with weekend service providers. Participants (n = 210): Hospital team members, including medical, nursing, and allied health professionals.	Hospital acute medical + surgical inpatient wards (n = 12) in two Australian hospitals	Positive impacts to patient flow and patient outcomes, enhancing equity of care, reducing impacts to nursing staff, improved workflow, ability to meet care guidelines, and access to patients’ family members on weekends Barriers were high costs to the organisation with poor understanding of cost-benefit, discontinuity of services, duplication of effort, and tendency for inexperienced staff to work weekends

SLP: speech-language pathologist.