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Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit
A Steiner1, B Walsh, R M Pickering
1Departments of Geriatric Medicine and Social Work Studies, University of Southampton, Murray Building, Southampton SO17 1BJ, UK. steiner@cats.ucsc.edu
Objectives:
To compare post-acute intermediate care in an inpatient nurse-led unit with conventional post-acute care on general medical wards of an acute hospital and to examine the model of care in a nurse-led unit.
Design:
Randomised controlled trial with six month follow up.
Setting:
Urban teaching hospital and surrounding area, including nine community hospitals.
Participants:
238 patients accepted for admission to nurse-led unit.
Interventions:
Care in nurse-led unit or usual post-acute care.
Main Outcome Measures:
Patients' length of stay, functional status, subsequent move to more dependent living arrangement.
Results:
Inpatient length of stay was significantly longer in the nurse-led unit than in general medical wards (14.3 days longer (95% confidence interval 7.8 to 20.7)), but this difference became non-significant when transfers to community hospitals were included in the measure of initial length of stay (4.5 days longer (-3.6 to 12.5)). No differences were observed in mortality, functional status, or living arrangements at any time. Patients in the nurse-led unit received significantly fewer minor medical investigations and, after controlling for length of stay, significantly fewer major reviews, tests, or drug changes.
Conclusions:
The nurse-led unit seemed to be a safe alternative to conventional management, but a full accounting of such units' place in the local continuum of care and the costs associated with acute hospitals managing post-acute patients is needed if nurse-led units are to become an effective part of the government's recent commitment to intermediate care.