An evaluation of nurse-led team care within a rehabilitation ward for elderly people. Substitution of a nursing-led inpatient unit for acute services: randomized controlled trial of outcomes and cost of nursing-led intermediate care. The effectiveness of intermediate care in a nursing-led in-patient unit. Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit. The feasibility and effectiveness of nursing beds. Subacute care. A competitive response to providing geriatric care. Patient outcomes for the chronically critically ill: special care unit versus intensive care unit.
This small exploratory study evaluated the effects of introducing a system of nurse-led team care on a ward providing intensive nursing and rehabilitation to elderly people. A quasi-experimental design compared three variables between the study ward and two similar wards within the unit. These were: quality of care, job satisfaction, length of patient stay. Quantitative data were complemented by semi-structured interviews with team members and by observation of team meetings. Quality of care scores showed an improvement on the study ward, but no difference on the main comparison ward. There were no differences between nurse job satisfaction between the study and comparison wards or in length of patient stay throughout the period of evaluation. Observation of team meetings suggested that communication was more structured and focused on the study ward and that patient goals were more clearly specified. Interviews suggested three main factors in successful implementation of the change to nurse-led team care: commitment of the team, open communication about difficulties, the support of managers and medical staff. The main effects noted were: partnership with patients, equality between team members, improved decision making and quality of care. Further studies of nurse-led team care are required, and the stress and anxiety for staff consequent on developing the nurse's role in this way should be considered. To evaluate the outcome and cost of transfer to a nursing-led inpatient unit for 'intermediate care'. The unit was designed to replace a period of care in acute hospital wards and promote recovery before discharge to the community.
                Randomized controlled trial comparing outcomes of care on a nursing-led inpatient unit with the system of consultant-managed care on a range of acute hospital wards.
                hospital wards in an acute inner-London National Health Service trust.
                175 patients assessed to be medically stable but requiring further inpatient care, referred to the unit from acute wards.
                89 patients were randomly allocated to care on the unit (nursing-led care with no routine medical intervention) and 86 to usual hospital care.
                Length of hospital stay, discharge destination, functional dependence (Barthel index) and direct healthcare costs.
                Care in the unit had no significant impact on discharge destination or dependence. Length of inpatient stay was significantly increased for the treatment group (P=0.036; 95% confidence interval 1.1-20.7 days). The daily cost of care was lower on the unit, but the mean total cost was pound sterlings 1044 higher-although the difference from the control was not significant (P=0.150; 95% confidence interval - pound sterlings 382 to pound sterlings 2471).
                The nursing-led inpatient unit led to longer hospital stays. Since length of stay is the main driver of costs, this model of care-at least as implemented here-may be more costly. However, since the unit may substitute for both secondary and primary care, longer-term follow-up is needed to determine whether patients are better prepared for discharge under this model of care, resulting in reduced primary-care costs. 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 (p0.05). 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 p0.05) 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. 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.
                Randomised controlled trial with six month follow up.
                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.
                Patients' length of stay, functional status, subsequent move to more dependent living arrangement.
                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.
                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. nan nan The purpose of this study was to compare the effects of a low-technology environment of care and a nurse case management case delivery system (special care unit, SCU) with the traditional high-technology environment (ICU) and primary nursing care delivery system on the patient outcomes of length of stay, mortality, readmission, complications, satisfaction, and cost. A sample of 220 chronically critically ill patients were randomly assigned to either the SCU (n = 145) or the ICU (n = 75). Few significant differences were found between the two groups in length of stay, mortality, or complications. However, the findings showed significant cost savings in the SCU group in the charges accrued during the study period and in the charges and costs to produce a survivor. The average total cost of delivering care was $5,000 less per patient in the SCU than in the traditional ICU. In addition, the cost to produce a survivor was $19,000 less in the SCU. Results from this 4-year clinical trial demonstrate that nurse case managers in a SCU setting can produce patient outcomes equal to or better than those in the traditional ICU care environment for long-term critically ill patients.