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


METHODS
Randomised controlled trial with six month follow up.


METHODS
Urban teaching hospital and surrounding area, including nine community hospitals.


METHODS
238 patients accepted for admission to nurse-led unit.


METHODS
Care in nurse-led unit or usual post-acute care.


METHODS
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.
Steiner
A
A
Departments of Geriatric Medicine and Social Work Studies, University of Southampton, Murray Building, Southampton SO17 1BJ, UK. steiner@cats.ucsc.edu
Walsh
B
B
Pickering
R M
RM
Wiles
R
R
Ward
J
J
Brooking
J I
JI
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D007380:Intermediate Care Facilities / Q000458:organization & administration*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009738:Nursing Service, Hospital / Q000458:organization & administration*; D010359:Patient Readmission / Q000706:statistics & numerical data; D010360:Patient Transfer; D011383:Progressive Patient Care / Q000458:organization & administration*; D011788:Quality of Life; D012046:Rehabilitation; D016896:Treatment Outcome