Availability of diagnostic tests drive success in hospital
29 June 2009
The most important factors for a successful stay in hospital
short-stay units (SSUs) are the types of diagnostic tests performed and
whether or not specialty consultations are needed. When hospitalists
staff these units, they can ensure that only patients who need readily
accessible services are admitted. These are the findings of a study
published in the Journal of Hospital Medicine.
SSUs provide an alternative to traditional inpatient services for
patients and exist in one-third of hospitals in the United States. These
units deliver efficient and high-quality care to patients requiring
short anticipated hospital stays for medical conditions like low-risk
chest pain, but little is known about what factors predict SSU success.
As demand for inpatient services have grown, SSUs have expanded
beyond 'observation medicine' to provide more complex inpatient services
(such as management of heart failure, diabetes out-of-control, and
transient ischemic attacks) in locations commonly adjacent to emergency
To inform the future direction of the rapidly expanding SSUs, the
researchers collected data on consecutive patients admitted to a SSU
over a four month period. 738 patients were eligible to the study, and
the majority (85%) were admitted with either a provisional diagnosis of
possible acute coronary syndrome or heart failure.
As SSUs were designed to care for patients during brief stays, visits
were considered successful when the length-of-stay was less than 72
hours and eventual admission to traditional inpatient services was not
Of the 738 patients, 71% (582) had successful SSU stays. Patients who
received inaccessible tests or specialty consultations were much more
likely to have an unsuccessful stay than patients who did not. For
example, patients who received a consultation had a 52% chance of having
an unsuccessful stay.
"We found that less accessible diagnostic tests and the need for
consultations had the greatest association with unsuccessful stays,"
said lead researcher Dr. Brian Lucas, of Stroger Hospital of Cook County
and Rush University Medical Center, Illinois, USA.
"From this we concluded that hosptialists who staff SSUs should focus
administratively toward gaining access to services that their patients
will need. Also, hospitalists can help emergency department physicians
make admission-location decisions by discussing the potential needs of
the patient prior to SSU admission."
"Among very-low or low-risk patients-the types of patients who are
typically admitted to SSUs-considering what services patients will need
is more important than further refining their clinical risk," added
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