Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unitCommentary: Problems with randomised consentAuthors' reply
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7284.453 (Published 24 February 2001) Cite this as: BMJ 2001;322:453
Abstract
Objectives: To compare post-acute intermediate care in an inpatient nurse-led unit with conventional post-acute care on general medical wards of an acute hospital and to examine the model of care in a nurse-led unit.
Design: Randomised controlled trial with six month follow up.
Setting: Urban teaching hospital and surrounding area, including nine community hospitals.
Participants: 238 patients accepted for admission to nurse-led unit.
Interventions: Care in nurse-led unit or usual post-acute care.
Main outcome measures: Patients' length of stay, functional status, subsequent move to more dependent living arrangement.
Results: Inpatient length of stay was significantly longer in the nurse-led unit than in general medical wards (14.3 days longer (95% confidence interval 7.8 to 20.7)), but this difference became non-significant when transfers to community hospitals were included in the measure of initial length of stay (4.5 days longer (−3.6 to 12.5)). No differences were observed in mortality, functional status, or living arrangements at any time. Patients in the nurse-led unit received significantly fewer minor medical investigations and, after controlling for length of stay, significantly fewer major reviews, tests, or drug changes.
Conclusions: The nurse-led unit seemed to be a safe alternative to conventional management, but a full accounting of such units' place in the local continuum of care and the costs associated with acute hospitals managing post-acute patients is needed if nurse-led units are to become an effective part of the government's recent commitment to intermediate care.
Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit
- Andrea Steiner, senior lecturer (steiner{at}cats.ucsc.edu)a,
- Bronagh Walsh, research fellowb,
- Ruth M Pickering, lecturerc,
- Rose Wiles, senior research fellowd,
- Jilly Ward, research nursee,
- a Departments of Geriatric Medicine and Social Work Studies, University of Southampton, Murray Building, Southampton SO17 1BJ
- b School of Nursing and Midwifery, University of Southampton
- c Medical Statistics Group, Health Care Research Unit, Southampton General Hospital, Southampton SO16 6YD
- d School of Health Professions and Rehabilitation Sciences, University of Southampton
- e Elderly Care Research Unit, University Department of Geriatric Medicine, Southampton General Hospital
- Department of Health Studies, University of York, York YO10 5DQ
- Correspondence to: A Steiner, Department of Community Studies, University of California Santa Cruz, 1156 High Street, Santa Cruz, CA, USA 95064
Abstract
Objectives: To compare post-acute intermediate care in an inpatient nurse-led unit with conventional post-acute care on general medical wards of an acute hospital and to examine the model of care in a nurse-led unit.
Design: Randomised controlled trial with six month follow up.
Setting: Urban teaching hospital and surrounding area, including nine community hospitals.
Participants: 238 patients accepted for admission to nurse-led unit.
Interventions: Care in nurse-led unit or usual post-acute care.
Main outcome measures: Patients' length of stay, functional status, subsequent move to more dependent living arrangement.
Results: Inpatient length of stay was significantly longer in the nurse-led unit than in general medical wards (14.3 days longer (95% confidence interval 7.8 to 20.7)), but this difference became non-significant when transfers to community hospitals were included in the measure of initial length of stay (4.5 days longer (−3.6 to 12.5)). No differences were observed in mortality, functional status, or living arrangements at any time. Patients in the nurse-led unit received significantly fewer minor medical investigations and, after controlling for length of stay, significantly fewer major reviews, tests, or drug changes.
Conclusions: The nurse-led unit seemed to be a safe alternative to conventional management, but a full accounting of such units' place in the local continuum of care and the costs associated with acute hospitals managing post-acute patients is needed if nurse-led units are to become an effective part of the government's recent commitment to intermediate care.
Footnotes
Funding The study was supported by a University of Southampton research studentship for BW, based in the School of Nursing and Midwifery, and by a grant from the NHSE R&D Directorate South and West (D/10/11.97/Steiner).
Competing interests None declared
Commentary: Problems with randomised consent
- David J Torgerson, reader (djt6{at}york.ac.uk)
- a Departments of Geriatric Medicine and Social Work Studies, University of Southampton, Murray Building, Southampton SO17 1BJ
- b School of Nursing and Midwifery, University of Southampton
- c Medical Statistics Group, Health Care Research Unit, Southampton General Hospital, Southampton SO16 6YD
- d School of Health Professions and Rehabilitation Sciences, University of Southampton
- e Elderly Care Research Unit, University Department of Geriatric Medicine, Southampton General Hospital
- Department of Health Studies, University of York, York YO10 5DQ
Authors' reply
Footnotes
BMJ publications on the issue of informed consent are accessible at bmj.com/cgi/collection/informed_consent