The effectiveness of intermediate care in a nursing-led in-patient unit

• Published in: International journal of nursing studies Vol. 37; no. 2; pp. 153 - 161
• Main Authors: Griffiths, Peter, Wilson-Barnett, Jenifer, Richardson, Gerald, Spilsbury, Karen, Miller, Fiona, Harris, Ruth
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.04.2000; Elsevier Science
• Subjects: Activities of Daily Living; Analysis of Variance; Biological and medical sciences; Effectiveness; Evaluation; Female; Health and social institutions; Hospital Units; Hospitals; Humans; Inpatient treatment units; Intermediate care; London; Male; Medical sciences; Nurse led care; Nurse-managed care; Nursing; Nursing Care - methods; Nursing-led in-patient units; Organization; Outcome Assessment (Health Care); Patient Care Management - methods; Patient Discharge; Patients; Public health. Hygiene; Public health. Hygiene-occupational medicine; Randomised controlled trial; United Kingdom; Europe; London; Evaluation; Intermediate care; Nursing-led in-patient units; Nurse-managed care; Randomised controlled trial; Human; Health system; Organization; Residence time; Health staff; Health; Managed care; Hospital ward; Profit; Hospitalization; Public health; Nurse
• ISSN: 0020-7489; 1873-491X
• DOI: 10.1016/S0020-7489(99)00061-9

In order to assess the potential for a nursing-led in-patient unit (NLIU) to substitute for a period of care in the acute hospital environment and promote recovery before discharge, a randomised controlled trial was conducted. The setting was an acute inner London hospital trust, part of the UK's national health service. Of patients referred to a NLIU from acute wards, 80 were randomly assigned to usual care (remain in normal hospital system) and 97 to the NLIU (nursing-led care with no routine medical involvement). Patients were identified as medically stable but in need of additional nursing intervention by referring medical staff prior to full nursing assessment of suitability. Outcomes compared included functional dependence (Barthel Index), discharge destination and length of hospital stay. Inputs from nursing, paramedical and medical staff were measured. There was no significant difference in functional independence at discharge ( p>0.05). Patients undergoing usual care stayed in hospital for less time (mean difference 18 days, p<0.01) but the same number of patients were in hospital 90 days after recruitment (23% NLIU, 24% usual care p>0.05) due to re-admissions. The model of care implemented differed considerably from that described in the literature with the NLIU having significantly fewer qualified nurses (RNs). Although the anticipated benefits of the NLIU were not demonstrated, the study does not conclude that the model should be rejected. Factors driving length of stay need to be further investigated, as does the possibility of post-discharge benefits. The NLIU does offer some potential to substitute for acute care but also appears to substitute for a period of primary care.