Učinkovitost prijelazne skrbi u bolničkim jedinicama koje vode medicinske sestre
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 methods
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.
Laički sažetak
Učinkovitost prijelazne skrbi u bolničkim jedinicama koje vode medicinske sestre
Bolesnici koji boluju od akutnih bolesti i primljeni su u bolnicu, obično su primljeni se smještaju na odjel akutne njege koji pruža mnoge usluge. No, dok se oporavljaju od bolesti oni možda neće trebati sve te intezivne usluge te će se trebati pripremiti za odlazak kući. Bolničke jedinice kojima upravljaju medicinske sestre, za razliku od liječnika, osmišljene su da bi pripremile bolesnika za odlazak kući. U ovom Cochrane sustavnom pregledu analizirano je deset studija, u koje je bilo uključeno više od 1800 bolesnika, kako bi se utvrdilo da li bolesnici poslani u bolničke jedinice koje vode medicinske sestre imaju od toga koristi ili da barem nisu prošli gore od bolesnika koji borave na odjelima gdje se pruža uobičajena skrb. U odnosu na uobičajenu skrb, bolesnici smješteni u jedinice koje su vodile medicinske sestre funkcionirali su bolje i osjećali su se bolje; više bolesnika otpušteno je kući, a ne u ustanovu nakon 3 mjeseca (ali ne nakon 6 mjeseci); manje ih je ponovo primljeno natrag u bolnicu odmah nakon otpusta, ali su ostali duže u bolnici. Broj smrtnih slučajeva za vrijeme boravka u bolnici i 3 do 6 mjeseci nakon otpusta bio je sličan između obje vrste odjela (no postojao je trend većeg broja ranijih smrti u jedinicama koje su vodile medicinske sestre, što treba detaljnije istražiti). Još uvijek se ne zna da li takvi odjeli koje vode medicinske sestre štede novac‐ studije u Velikoj Britaniji ustanovile su da su takvi odjeli mnogo skuplji od odjela uobičajene skrbi, dok su studije provedene u Sjedinjenim Američkim Državama pokazale da su jeftinije od uobičajene skrbi.
