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Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit

Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit
Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit
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.
therapeutic nursing, unblocking beds, post-acute intermediate care unit
0959-8138
453 - 460
Steiner, A.
5edd1b04-ec65-44e8-8f09-11553a02f0bb
Walsh, B.
5818243e-048d-4b4b-88c5-231b0e419427
Pickering, R.M.
4a828314-7ddf-4f96-abed-3407017d4c90
Wiles, R.
5bdc597b-716c-4f60-9f45-631ecca25571
Ward, J.
e3803cde-deb2-46d2-be24-b6bfd18c8742
Brooking, J. I.
0ae01d0a-d55c-4022-92ae-7d9ab3e45c83
Steiner, A.
5edd1b04-ec65-44e8-8f09-11553a02f0bb
Walsh, B.
5818243e-048d-4b4b-88c5-231b0e419427
Pickering, R.M.
4a828314-7ddf-4f96-abed-3407017d4c90
Wiles, R.
5bdc597b-716c-4f60-9f45-631ecca25571
Ward, J.
e3803cde-deb2-46d2-be24-b6bfd18c8742
Brooking, J. I.
0ae01d0a-d55c-4022-92ae-7d9ab3e45c83

Steiner, A., Walsh, B., Pickering, R.M., Wiles, R., Ward, J. and Brooking, J. I. (2001) Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit. BMJ, 322 (7284), 453 - 460. (doi:10.1136/bmj.322.7284.453).

Record type: Article

Abstract

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.

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More information

Published date: 24 February 2001
Keywords: therapeutic nursing, unblocking beds, post-acute intermediate care unit

Identifiers

Local EPrints ID: 24517
URI: http://eprints.soton.ac.uk/id/eprint/24517
ISSN: 0959-8138
PURE UUID: 8a98a9be-3faa-467e-8b4a-876676c07622
ORCID for B. Walsh: ORCID iD orcid.org/0000-0003-1008-0545

Catalogue record

Date deposited: 31 May 2006
Last modified: 09 Jan 2022 02:57

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Contributors

Author: A. Steiner
Author: B. Walsh ORCID iD
Author: R.M. Pickering
Author: R. Wiles
Author: J. Ward
Author: J. I. Brooking

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