Impact of an emergency department short-stay unit on clinical management and quality of hospital care indicators

Objective.

The primary aim was to study the impact that creating a short-stay unit (SSU) had on clinical management and quality of care indicators of a hospital overall and its conventional wards. The secondary aim was to establish values for those indicators and determine the level of satisfaction of patients admitted to the SSU.

Material and method. Quasi-experimental before-after study of the impact of establishing a SSU in a tertiary care teaching hospital. The first period (without the SSU) was in 2012, the second (with the SSU) was from 2013 through 2015. To meet the first objective we selected cases in 2012 in which patients were hospitalized for problems related to the 5 diagnosis-related groups most often admitted to the SSU in the second period. To meet the second objective, we studied all patients admitted to the SSU in the second period Data related to quality of care and clinical management were analyzed retrospectively. and asked them to complete a questionnaire on patient satisfaction.

Results.

A total of 76 241 admissions were included: 19 090 in the first period and 57 151 in the second (2705 admissions were to the SSU). The mean hospital stay decreased in the second period (incidence rate ratio [IRR], 0.93; 95% CI, 0.91–0.95); the mean stay also decreased on medical wards (IRR, 0.94; 95% CI, 0.92–0.96) with no impact on adverse outcomes. The mean stay in the SSU was under 3 days in spite of an increase in the weighted mean (IRR,1.08; 95% CI, 1.05–1.11). A total of 320 questionnaires were received (11.8% response rate); all aspects were assessed very

highly.

Conclusions.

Our experience suggests that opening a SSU could improve clinical management and quality of care indicators for a hospital overall and for its conventional wards in the context of the GRDs that most frequently lead to admissions.