23-hour care centre: changing the culture of care

A 23-hour Care Centre was created at a principal referral hospital in Sydney in 2003. Its primary aim was to provide efficient and high quality care to patients requiring a brief stay in hospital for surgical or medical procedures, within one coordinated unit.

The features underlying the 23-hour Care Centre as an innovative model of care were the clinical guideline driven approach and nurse-initiated discharge. All patients, emergency and elective as well as surgical and medical, who fitted the following criteria were admitted as '23-hour patients' to the Centre. The criteria were: absolute expectation of discharge within 24 hours; pre-admission screening by a nurse screener (if elective admission); agreed clinical guideline in place; and, agreement to protocol-based, nurse-initiated discharge.

Following the first three months of the 23-hour Care Centre, 1601 patients utilised the 23-hour Care Centre as follows: 593 day only patients, 410 DOSA (day of surgery admission) patients and 598 23-hour patients. Excluding inappropriate admissions, overall discharge compliance was 83%.

From the results generated throughout the trial it has become evident that the new clinical area offers a workable system of health care delivery for patients who require a brief stay in hospital, as it promotes an efficient use of hospital beds and services without compromising patient outcomes. However, further research is required to compare the efficiency and outcomes of care directly with that provided by the traditional inpatient hospital system.