title: Outpatient Quick Diagnosis Units for the evaluation of suspected severe diseases: an observational, descriptive study.
abstract: BACKGROUND
  Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal.
  
  
  OBJECTIVE
  Our goal was to describe the functioning of a Quick Diagnosis Unit in a Spanish public university hospital after evaluating 1,000 consecutive patients. We also aimed to ascertain the degree of satisfaction among Quick Diagnosis Unit patients and the costs of the model compared to conventional hospitalization practices.
  
  
  METHODS
  Observational, descriptive study.
  
  
  METHODS
  Our sample comprised 1,000 patients evaluated between November 2008 and January 2010 in the Quick Diagnosis Unit of a tertiary university public hospital in Barcelona. Included patients were those who had potentially severe diseases and would normally require hospital admission for diagnosis but whose general condition allowed outpatient treatment. We analyzed several variables, including time to diagnosis, final diagnoses and hospitalizations avoided, and we also investigated the mean cost (as compared to conventional hospitalization) and the patients' satisfaction.
  
  
  RESULTS
  In 88% of cases, the reasons for consultation were anemia, anorexia-cachexia syndrome, febrile syndrome, adenopathies, abdominal pain, chronic diarrhea and lung abnormalities. The most frequent diagnoses were cancer (18.8%; mainly colon cancer and lymphoma) and Iron-deficiency anemia (18%). The mean time to diagnosis was 9.2 days (range 1 to 19 days). An estimated 12.5 admissions/day in a one-year period (in the internal medicine department) were avoided. In a subgroup analysis, the mean cost per process (admission-discharge) for a conventional hospitalization was 3,416.13 Euros, while it was 735.65 Euros in the Quick Diagnosis Unit. Patients expressed a high degree of satisfaction with Quick Diagnosis Unit care.
  
  
  CONCLUSIONS
  Quick Diagnosis Units represent a useful and cost-saving model for the diagnostic study of patients with potentially severe diseases. Future randomized study designs involving comparisons between controls and intervention groups would help elucidate the usefulness of Quick Diagnosis Units as an alternative to conventional hospitalization.
authors.affiliation: Department of Internal Medicine, Hospital Clínic, Institut d'Investigacio Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain. xavbosch@clinic.ub.es
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.forename: Anna
authors.initials: A
authors.lastname: Foix
authors.forename: Anna
authors.initials: A
authors.lastname: Jordan
authors.forename: Antonio
authors.initials: A
authors.lastname: Coca
authors.forename: Alfonso
authors.initials: A
authors.lastname: López-Soto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003933:Diagnosis; D005260:Female; D006779:Hospitals, Public; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards*; D013030:Spain; D055815:Young Adult