[Short-Stay Medical Unit, an alternative to conventional hospitalization]

[Prolonged hospitalization in patients admitted for acute heart failure in the short stay unit (EPICA-UCE study): study of associated factors]

BACKGROUND AND OBJECTIVE

To study the factors associated with prolonged hospitalization in patients admitted for acute heart failure (AHF) in Spanish short-stay units (SSUs).

PATIENTS AND METHODS

This was a multicentre, multipurpose cohort study with prospective follow-up including all patients admitted for AHF in the 11 SSUs of the EAHFE registry. Demographic data, previous illness, baseline cardiorespiratory and functional status, acute episode and admission and follow up variables at 60 days were recorded. The primary outcome was prolonged hospitalization in the SSU (>72h). A logistic regression model was used to control the effects of confounding factors.

RESULTS

Eight-hundred and nineteen patients were included with a mean age of 80.9 (SD 8.4) years, 483 (59.0%) being women. The median length stay was 3.0 (IQR 2.0-5.0) days with an in-hospital mortality of 2.7%. The independent factors associated with prolonged hospitalization were the coexistence of chronic obstructive pulmonary disease (odds ratio [OR] 1.56; 95% IC 1.02-2.38; P=.040) and anaemia (OR 1.72; 95% CI 1.21-2.44; P=.002), basal oxygen saturation<90% on arrival to the Emergency Department (OR 2.21, 95% CI 1.51-3.23; P<.001), hypertensive episode as the precipitating factor of the AHF (protective factor OR 0.49; 95% CI 0.26-0.93; P=.028) and admission on Thursday (OR 1.90; 95% CI 1.19-3.05; P=.008). There were no significant differences between both groups regarding to in-hospital mortality (2.4 vs. 3.0%), mortality (4.1 vs. 4.2%) or revisit at 60 days (18.4 vs. 21.6%).

CONCLUSIONS

Several factors including hypertensive episode, insufficiency respiratory, anaemia, chronic obstructive pulmonary disease, and admission on Thursday should be taken into account in patients with AHF admitted in SSU stay to avoid prolonged hospitalization.

[Impact of short-stay units on the quality of medical care in Spain]

OBJECTIVE

Short-stay units (SSUs) have been developed as an alternative to conventional hospitalisation. The aim of this study is to analyse the impact of short-stay units on the quality of medical care in Spain.

MATERIAL AND METHODS

A systematic review was performed by retrieving studies that analysed the results of SSUs in Spain, in terms of clinical effectiveness, efficiency and satisfaction among patients, using an electronic database search (Pubmed/Medline and Spanish Medical Index) and a review of selected references. The data collected included, mortality, length of stay and re-admission rates, as well as other variables.

RESULTS

Twenty-seven articles were found, with a great heterogeneity in both study design and type of SSU analysed. After analysing results, it was observed that SSUs in Spain provided effective clinical care. Low-quality evidence was also found supporting the hypothesis that SSUs are able to reduce overall length of stay in the whole hospital or department where they were created. There are not enough data to support any other advantages or benefits of SSUs, when compared with other hospitalisation units.

CONCLUSIONS

SSUs may be able to effectively improve clinical care in selected patients, and may help to shorten overall length of stay. Further research is needed in order to define their exact role and to establish their optimal model.

The Short Stay Unit as a new option for hospitals: a review of the scientific literature

Background

The short stay unit (SSU) is a ward providing targeted care for patients requiring brief hospitalization and dischargeable as soon as clinical conditions are resolved. Therefore, SSU is an alternative to the ordinary ward (OW) for the treatment of selected patients. The SSU model has been tested in only a few hospitals, and the literature lacks systematic evaluation of the impact of SSU use. The aim of our study was to evaluate the use of SSUs in terms of length of hospital stay, mortality and readmission rate.

Material/Methods

A random effect meta-analysis was carried out by consulting electronic databases. Studies were selected that focused on comparison between use of SSUs and OWs. Mean difference of length of stay was calculated within 95% confidence intervals.

Results

Six articles were selected, for a total of 21 264 patients. The estimated mean difference was −3.06 days (95% CI −4.71, −1.40) in favor of the SSU. The selected articles did not show any differences in terms of mortality and readmission rate.

Conclusions

Use of SSUs could reduce patient length of stay in hospital, representing an alternative to the ordinary ward for selected patients. A shorter period of hospitalization could reduce the risk of hospital-acquired infections, increase patient satisfaction and yield more efficient use of hospital beds. Findings of this study are useful for institutional, managerial and clinical decision-makers regarding the implementation of the SSU in a hospital setting, and for better management of continuity of care.