Effectiveness and safety of an emergency department short-stay unit as an alternative to standard inpatient hospitalization

Abstract

Study objectives: Emergency department (ED) short-stay units are emerging worldwide as an alternative to standard inpatient hospitalization. In our hospital, a 960-bed teaching tertiary institution for adults in Barcelona, Spain, with 118,000 ED visits a year, a 24-bed ED short-stay units for chronic patients with acute exacerbation has been in operation during winter periods (November to March) since 1997. After 6 years, we determine its efficacy and safety. Methods: This was a retrospective analysis of activity and quality outcomes, assessment of patient satisfaction levels using a specific self-scored protocol, and comparison of clinical characteristics of those patients with chronic obstructive pulmonary disease (COPD) admitted to the ED short-stay unit with those admitted to standard inpatient units. Results: A total of 4,439 patients were admitted at the ED short-stay unit from 1997/1998 to 2002/2003, with a progressive increase in the number of patients admitted per year (from 707 in 1997/1998 to 998 in 2002/2003). Mean length of stay ranged from 3.01 to 2.75 days, mortality rate from 2.5% to 6.8%, home discharge rate from 84% to 76.9%, and hospital readmission rate within the first week after discharge from 3.9% to 9.5%. In 98% of cases, patients were satisfied with their stay at the ED short-stay unit. Furthermore, during the past 2 winter periods, COPD patients admitted at the ED short-stay unit (n=735) were compared with those admitted to standard inpatient units (n=430). When adjusted by severity at admission, age, and previous hospitalization, results showed a significantly lower mean length of stay among ED short-stay unit patients (3.28 versus 11.63 days) but a higher hospital readmission rate at 7 days (9.9% versus 7%). Conclusion: In our experience, ED short-stay units may be effective and safe as an alternative to standard inpatient hospitalization for a selected group of patients with acute exacerbated chronic diseases during winter periods.