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.
Departments of Geriatric Medicine and Social Work Studies, University of Southampton, Murray Building, Southampton SO17 1BJ, UK. steiner@cats.ucsc.edu
A
A
Steiner
B
B
Walsh
R M
RM
Pickering
R
R
Wiles
J
J
Ward
J I
JI
Brooking
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