title: Does a specialist unit improve outcomes for hospitalized patients with Parkinson's disease?
abstract: OBJECTIVE
  Suboptimal management of Parkinson's disease (PD) medication in hospital may lead to avoidable complications. We introduced an in-patient PD unit for those admitted urgently with general medical problems. We explored the effect of the unit on medication management, length of stay and patient experience.
  
  
  METHODS
  We conducted a single-center prospective feasibility study. The unit's core features were defined following consultation with patients and professionals: specially trained staff, ready availability of PD drugs, guidelines, and care led by a geriatrician with specialty PD training. Mandatory staff training comprised four 1 h sessions: PD symptoms; medications; therapy; communication and swallowing. Most medication was prescribed using an electronic Prescribing and Administration system (iSOFT) which provided accurate data on time of administration. We compared patient outcomes before and after introduction of the unit.
  
  
  RESULTS
  The general ward care (n = 20) and the Specialist Parkinson's Unit care (n = 24) groups had similar baseline characteristics. On the specialist unit: less Parkinson's medication was omitted (13% vs 20%, p < 0.001); of the medication that was given, more was given on time (64% vs 50%, p < 0.001); median length of stay was shorter (9 days vs 13 days, p = 0.043) and patients' experience of care was better (p = 0.01).
  
  
  CONCLUSIONS
  If replicated and generalizable to other hospitals, reductions in length of stay would lead to significant cost savings. The apparent improved outcomes with Parkinson's unit care merit further investigation. We hope to test the hypothesis that specialized units are cost-effective and improve patient care using a randomized controlled trial design.
authors.affiliation: Department of Medicine for the Elderly, Royal Derby Hospital, Derby, UK. Electronic address: rob.skelly@nhs.net.
authors.forename: Rob
authors.initials: R
authors.lastname: Skelly
authors.affiliation: Department of Neurology, Royal Derby Hospital, Derby, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Brown
authors.affiliation: Research & Development Department, Royal Derby Hospital, Derby, UK.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Fakis
authors.affiliation: Research & Development Department, Royal Derby Hospital, Derby, UK.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Kimber
authors.affiliation: Research & Development Department, Royal Derby Hospital, Derby, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Downes
authors.affiliation: Specialist Assessment & Rehabilitation Centre, London Road Community Hospital, Derby, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Lindop
authors.affiliation: Specialist Assessment & Rehabilitation Centre, London Road Community Hospital, Derby, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Johnson
authors.affiliation: Specialist Assessment & Rehabilitation Centre, London Road Community Hospital, Derby, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bartliff
authors.affiliation: Department of Neurology, Royal Derby Hospital, Derby, UK.
authors.forename: Nin
authors.initials: N
authors.lastname: Bajaj
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care / Q000191:economics; D010300:Parkinson Disease / Q000191:economics / Q000534:rehabilitation*; D011446:Prospective Studies; D011788:Quality of Life; D013038:Specialization / Q000191:economics; D016896:Treatment Outcome
keywords: Errors; Hospitalization; Length of stay; Medication; Parkinson's disease; Specialist unit