Effectiveness of intermediate care in nursing‐led inpatient units

Abstract

Effectiveness of intermediate care in nursing-led inpatient units. Griffiths P.D., Edwards M.H., Forbes A., Harris R.L. & Ritchie G. (2007) Effectiveness of intermediate care in nursing-led in-patient units. Cochrane Database Systematic Reviews Issue 2, Art. No: CD002214. DOI: 10.1002/14651858.CD002214.pub3. Date of most recent substantive amendment: 18 January 2007. The full review report, including references, can be accessed using the digital object identifier, DOI: 10.1002/14651858.CD002214.pub3. Are nursing-led inpatient units effective in preparing patients for discharge from hospital compared to usual inpatient care? Cochrane review of quantitative studies. Nursing-led inpatient units (NLU) are just one of a range of services that have been suggested to manage more successfully the transition from hospital to home for patients with extended recovery times. Ten randomized or quasi-randomized controlled trials with a total of 1896 participants were included in the review. The methodological quality of the included studies was variable. Allocation concealment was used in only three. However, in three other studies researchers used randomized consent designs in which allocations could not be concealed. No statistically significant differences between the intervention and control were found in studies assessing the impact of NLU on inpatient mortality or mortality to longest follow-up. Discharge to institutional care was reduced for those treated in a NLU and functional status at discharge was increased. Early readmissions were also reduced. In one study, a NLU for treating the chronically critically ill was compared with standard intensive care unit (ICU) care. No statistically significant difference was found in mortality or length of inpatient stay. Early readmissions were reduced. The cost of care on the NLU was found to be higher in the United Kingdom studies but lower in those from the United States of America. There is some evidence that patients discharged from a NLU are better prepared for discharge, but this could be due to increased length of inpatient stays. No statistically significant adverse effects were reported, but the possibility of increased early mortality cannot be completely disregarded. Further high quality studies are needed to determine the safety of NLUs compared to usual care. Criteria need to be identified for assessing the suitability of patients for NLUs. The cost effectiveness of NLUs in comparison to other forms of intermediate care needs to be investigated. Wider consideration is needed of the perspectives of both clients and carers and how they view NLUs. Keywords: Cochrane review, intermediate care, nurse-led units CARUANA E. (2008) Griffiths P.D., Edwards M.H., Forbes A., Harris R.L. & Ritchie G. (2007) Effectiveness of intermediate care in nursing-led in-patient units. Journal of Advanced Nursing62(5), 532.