[Short-stay respiratory unit: a new option for inpatient care]

OBJECTIVE

The current pressure on conventional inpatient care units represents a very serious problem for respiratory medicine departments. The aim of this study was to analyze the impact of a new instrument --a short-stay respiratory unit-- on the quality of care delivered by the respiratory medicine department of a tertiary care hospital.

MATERIAL AND METHODS

The short-stay respiratory unit consisted of 4 conventional hospital beds managed by a pulmonologist. The beds were only used to treat patients diagnosed with exacerbation of chronic obstructive pulmonary disease or bronchial asthma, community-acquired pneumonia, or suspected lung cancer, and stays were intended to only last for up less than to 4 days. Analyzing a range of healthcare quality variables, we compared the quality of care delivered during the first 6 months the unit was in operation (October 2005 to March 2006) to that delivered in the same period 12 months earlier.

RESULTS

The study included 147 patients admitted to the short-stay unit. The mean (SD) age of the patients was 64 (17) years and 79% were men. The mean length of stay was 3.3 (1.6) days--only 1.4% of patients stayed for longer than 4 days--and the readmission rate was 2.7%. There were no deaths. The existence of the short-stay respiratory unit led to a 30% decrease in the overall mean length of stay in the respiratory medicine department (11.8 [4.6] vs 8.3 [2.6] days; P< .001), and the readmission rate fell from 21% to 15% (P< .05). While there were no differences in mortality between the 2 periods, the complexity of diseases treated by the respiratory medicine department showed an increase of 9.2% (P< .001).

CONCLUSIONS

A short-stay respiratory unit can improve the efficiency of care delivered by a respiratory medicine department by reducing both the mean duration of hospitalization and the readmission rate, without a reduction in the complexity of diseases treated or a need for additional resources.

[Continuity of medical care. Evaluation of a collaborative program between hospital and Primary Care]

The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike.