Substitution of a nursing-led inpatient unit for acute services: randomized controlled trial of outcomes and cost of nursing-led intermediate care

P Griffiths, Ruth Harris, G Richardson, N Hallett, S Heard, J Wilson-Barnett

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42 Citations (Scopus)

Abstract

Objectives: to evaluate the outcome and cost of transfer to a nursing-led inpatient unit for 'intermediate care'. The unit was designed to replace a period of care in acute hospital wards and promote recovery before discharge to the community. Design: randomized controlled trial comparing outcomes of care on a nursing-led inpatient unit with the system of consultant-managed care on a range of acute hospital wards. Setting: hospital wards in an acute inner-London National Health Service trust. Subjects: 175 patients assessed to be medically stable but requiring further inpatient care, referred to the unit from acute wards. Intervention: 89 patients were randomly allocated to care on the unit (nursing-led care with no routine medical intervention) and 86 to usual hospital care. Main outcome measures: length of hospital stay, discharge destination, functional dependence (Barthel index) and direct healthcare costs. Results: care in the unit had no significant impact on discharge destination or dependence. Length of inpatient stay was significantly increased for the treatment group (P=0.036; 95% confidence interval 1.1-20.7 days). The daily cost of care was lower on the unit, but the mean total cost was pound1044 higher-although the difference from the control was not significant (P=0.150; 95% confidence interval -pound382 to pound2471). Conclusions: the nursing-led inpatient unit led to longer hospital stays. Since length of stay is the main driver of costs, this model of care-at least as implemented here-may be more costly. However, since the unit may substitute for both secondary and primary care, longer-term follow-up is needed to determine whether patients are better prepared for discharge under this model of care, resulting in reduced primary-care costs.
Original languageEnglish
Pages (from-to)483 - 488
Number of pages6
JournalAge and Ageing
Volume30
Issue number6
DOIs
Publication statusPublished - 2001

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