Effectiveness of nursing-led inpatient care for patients with post-acute health care needs: secondary data analysis from a programme of randomized controlled trials.
OBJECTIVE
To determine whether transfer to a nursing-led inpatient unit (NLIU) prior to discharge from hospital can improve clinical outcome and reduce length of stay and readmission rate for medically stable post-acute patients assessed as requiring inpatient care.


METHODS
Retrospective secondary data analysis of individual patient data (n=471) from a programme of three, purposefully replicated, pragmatic randomized controlled trials. Patients were referred to the NLIU by their consultant (attending doctor/surgeon) for nursing-led subacute/post-acute care and randomly allocated to a treatment group for planned transfer to the NLIU for the remainder of their hospital stay or to a control group for traditional consultant-led care in acute wards. Outcome measures were physical function (Barthel Index), length of stay, discharge destination, mortality, psychological well-being (General Health Questionnaire-12), health-related distress (Nottingham Health Profile Distress Index), incidence of complications and readmission within 7, 28, 90 and 180 days.


RESULTS
Patients allocated to the NLIU showed greater improvement in physical function (P<0.001) and were more likely to be discharged to live independently in the community than controls [odds ratio (OR)=0.42, P=0.001] although they spent longer in hospital (P= 0.003). They showed greater improvement in psychological well-being (P = 0.001) and health-related distress (P =0.025) and a lower incidence of pressure ulcers (OR=0.33, P=0.011).


CONCLUSIONS
Transfer to a NLIU can have a beneficial effect on outcomes of care for post-acute patients with complex health and social needs although length of stay is longer. This study strengthens the evidence of effectiveness of the NLIU model of care and provides evidence of effectiveness of post-acute and subacute models of care.
Harris
Ruth
R
Faculty of Health and Social Care Services, St George's University of London/Kingston University, London, UK. ruharris@hscs.sgul.ac.uk
Wilson-Barnett
Jenifer
J
Griffiths
Peter
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013222:State Medicine; D006113:United Kingdom