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Meta-Analysis
. 2007 Apr 18;2007(2):CD002214.
doi: 10.1002/14651858.CD002214.pub3.

Effectiveness of intermediate care in nursing-led in-patient units

P D Griffiths  1 , M H Edwards, A Forbes, R L Harris, G Ritchie
Affiliations
Meta-Analysis

Effectiveness of intermediate care in nursing-led in-patient units

P D Griffiths et al. Cochrane Database Syst Rev. .

Abstract

Background: The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in order to manage more successfully the transition between hospital and home for patients with extended recovery times. This is an update of an earlier review published in The Cochrane Library in Issue 3, 2004.

Objectives: To determine whether nursing-led inpatient units are effective in preparing patients for discharge from hospital compared to usual inpatient care.

Search strategy: We searched The Cochrane Library, the Specialized Register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, MEDLINE, CINAHL, EMBASE, BNI and HMIC databases. Citation searches were undertaken on the science and social science citation indices. Authors were contacted to identify additional data. The initial search was done in January 2001. The register search was updated in October 2006, the other database searches were updated in November 2006 and the citation search was run in January 2007.

Selection criteria: Controlled trials and interrupted time series designs that compared the NLU to usual inpatient care managed by doctors. Patients over 18 years of age following an acute hospital admission for a physical health condition.

Data collection and analysis: Two reviewers independently extracted data and assessed study quality.

Main results: Ten random or quasi-random controlled trials reported on a total of 1896 patients. There was no statistically significant effect on inpatient mortality (OR 1.10, 95% CI 0.56 to 2.16) or mortality to longest follow up (OR 0.92, 95% CI 0.65 to 1.29) but higher quality studies showed a larger non-significant increase in inpatient mortality (OR 1.52, 95% CI 0.86 to 2.68). Discharge to institutional care was reduced for the NLU (OR 0.44 95% CI 0.22 to 0.89) and functional status at discharge increased (SMD 0.37, 95% CI 0.20 to 0.54) but there was a near significant increase in inpatient stay (WMD 5.13 days 95% CI -0.5 days to 10.76 days). Early readmissions were reduced (OR 0.52 95% CI 0.34 to 0.80). One study compared a NLU for the chronically critically ill with ICU care. Mortality (OR 0.62 95% CI 0.35 to 1.10) and length of inpatient stay differ did not differ (WMD 2 days, 95% CI 10.96 to -6.96 days). Early readmissions were reduced (OR 0.33 95% CI 0.12 to 0.94). Costs of care on the NLU were higher for UK studies but lower for US based studies.

Authors' conclusions: There is some evidence that patients discharged from a NLU are better prepared for discharge but it is unclear if this is simply a product of an increased length of inpatient stay. No statistically significant adverse effects were noted but the possibility of increased early mortality cannot be discounted. More research is needed.

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Conflict of interest statement

Peter Griffiths and Ruth Harris have both published studies that were included in this review. Other reviewers considered the methodological quality of these studies.

Figures

1.1
1.1. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 1 Inpatient mortality.
1.2
1.2. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 2 Early post discharge death (4‐6 weeks).
1.3
1.3. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 3 Mortality within 3 months of admission (12 weeks / 90 days).
1.4
1.4. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 4 Mortality within 6 months of admission (24 weeks / 180 days).
1.5
1.5. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 5 Mortality to longest follow up (within 6 months).
1.6
1.6. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 6 Discharge to institutional care.
1.7
1.7. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 7 Independent at discharge.
1.8
1.8. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 8 Institutional care to longest follow up.
1.9
1.9. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 9 Functional Status.
1.10
1.10. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 10 Change in functional Status (admission to discharge).
1.11
1.11. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 11 Length of stay to first discharge from hospital setting.
1.12
1.12. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 12 Length of stay to first discharge home.
1.13
1.13. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 13 Early readmission (within 30 days).
1.14
1.14. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 14 Quality of life / health status.
1.15
1.15. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 15 Quality of life / health status change scores only.
1.16
1.16. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 16 Psychological wellbeing.
1.17
1.17. Analysis
Comparison 1 NLU vs general inpatient care, Outcome 17 Satisfaction.
2.1
2.1. Analysis
Comparison 2 NLU vs ICU, Outcome 1 Inpatient mortality.
2.2
2.2. Analysis
Comparison 2 NLU vs ICU, Outcome 2 Mortality to longest follow up (Up to 24 months).
2.3
2.3. Analysis
Comparison 2 NLU vs ICU, Outcome 3 Discharge to institutional care.
2.4
2.4. Analysis
Comparison 2 NLU vs ICU, Outcome 4 Length of stay to first discharge home.
2.5
2.5. Analysis
Comparison 2 NLU vs ICU, Outcome 5 Early readmission (within 30 days).
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