Effectiveness of intermediate care in nursing-led in-patient units

Griffiths, Paul D.; Edwards, ME; Forbes, A; Harris, RL; Ritchie, G

doi:10.1002/14651858.cd002214

Cited by 14 publications

(17 citation statements)

References 4 publications

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“…There was evidence that professional boundaries were flexible in the CH setting, with role diversification apparent, especially for nurses [61-67]. This diversification of roles often challenged existing professional boundaries and, at its most extreme, could lead to breakdowns in communication with overall patient care suffering [62].…”

Section: Resultsmentioning

confidence: 99%

Community hospitals – the place of local service provision in a modernising NHS: an integrative thematic literature review

et al. 2006

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Section: Resultsmentioning

confidence: 99%

Community hospitals – the place of local service provision in a modernising NHS: an integrative thematic literature review

et al. 2006

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“…In the community setting, service delivery models aimed to facilitate rehabilitation and hospital discharge, or more holistically care close to home, have been denominated in various ways like “hospital at home”, “nursing led in-patient units”, “general practitioner run community hospitals”, “intermediate care in nursing homes” and “community care centres” [32,33], and in the UK they have been named “intermediate care”. A recent realist review has been published by Pearson et al [34] with the aim to build up a conceptual framework for intermediate care to investigate under which circumstances it is likely to be feasible and effective and, most important, cost-effective.…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic, clinical and organisational factors associated with delayed hospital discharges: a cross-sectional study

Lenzi

Mongardi

Rucci

et al. 2014

BMC Health Serv Res

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BackgroundEvidence from studies conducted in Western countries indicates that a significant proportion of hospital beds are occupied by patients who experience a delayed hospital discharge (DHD). However, evidence about this topic is lacking in Italy, and little is known on the patients’ and organisational characteristics that influence DHDs. Therefore, we carried out a survey in all the hospitals of a Northern Italian region to analyse the prevalence and the determinants of DHD.MethodsA cross-sectional study was carried out during an index period of 15 days in 256 operative units in Emilia-Romagna, a Northern Italian region with 4.4 million inhabitants, to identify patients medically fit for discharge but still hospitalised. The characteristics of these patients (n = 510) were compared with all the other patients (n = 5,815) hospitalised in the same operative units during the index period using multilevel logistic regression models.ResultsThe one-day prevalence of DHD was 8.1%. More than half of DHD patients (52.7%) waited to access long-term/rehabilitation units or residential care homes, 16.7% experienced a delay for family-related reasons, and 14.5% were waiting to be admitted to other rehabilitation services. Among DHD patients hospitalised in long-term/rehabilitation units, 45.3% were waiting to be transferred to residential care homes. Patients’ characteristics associated with a higher likelihood of DHD in multilevel logistic regression were older age, provision of intensive care, a diagnosis of dementia, tumours or femoral/shoulder fractures, and a number of comorbidities. Patients hospitalised in long-term/rehabilitation units, as well as in orthopaedics/traumatology units, were significantly more likely to have a DHD compared with patients hospitalised in general surgery units. Moreover, compared with Local Health Authority Hospitals, being hospitalised in Hospital Trusts was associated with a higher likelihood of DHD.ConclusionsAlthough the prevalence of DHD in the present study is markedly lower than that reported in the literature, we submit that the DHD problem should be addressed with major organisational innovations, with a special focus on the ageing of the population and epidemiological trends. Organisational changes imply new ways of managing emerging clusters of patients whose needs are not efficiently or effectively met by traditional organisation models and services.

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“…This model included a specialist therapy team and a weekly visit from a geriatrician or rehabilitation medicine physician and therefore differs from many of the nurse led inpatient studies 9. Cross sectional work suggests that outcomes were better patients in long term care who received rehabilitation,10 11 but to date there is no evidence from intervention studies to support offering rehabilitation in a long term care setting or on the effectiveness of alternate sites and approaches 12…”

Section: Discussionmentioning

confidence: 99%

Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial

Crotty

Whitehead

Wundke

et al. 2005

BMJ

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Objective To assess the effectiveness of moving patients who are waiting in hospital for a long term care bed to an off-site transitional care facility. Design Randomised controlled trial. Setting Three public hospitals in Southern Adelaide. Participants 320 elderly patients (mean age 83 years) in acute hospital beds (212 randomised to intervention, 108 to control). Interventions A transitional care facility where all patients received a single assessment from a specialist elder care team and appropriate ongoing therapy. Main outcome measures Length of stay in hospital, rates of readmission, deaths, and patient's functional level (modified Barthel index), quality of life (assessment of quality of life), and care needs (residential care scale) at four months. Results From admission, those in the intervention group stayed a median of 32.5 days (95% confidence interval 29 to 36 days) in hospital. In the control group the median length of stay was 43.5 days (41 to 51 days) (95% confidence interval for difference 6 to 16 days).

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Effectiveness of intermediate care in nursing-led in-patient units

Abstract: Analysis 1.2. Comparison 1 NLU vs general inpatient care, Outcome 2 Early post discharge death (4-6 weeks).. . Analysis 1.3. Comparison 1 NLU vs general inpatient care, Outcome 3 Mortality within 3 months of admission (12 weeks / 90 days

Cited by 14 publications

References 4 publications

Community hospitals – the place of local service provision in a modernising NHS: an integrative thematic literature review

Community hospitals – the place of local service provision in a modernising NHS: an integrative thematic literature review

Sociodemographic, clinical and organisational factors associated with delayed hospital discharges: a cross-sectional study

Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial

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