BMJ 2001;322:453-460 ( 24 February )

Papers

Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit

Andrea Steiner, senior lecturer, ^a Bronagh Walsh, research fellow, ^b Ruth M Pickering, lecturer, ^c Rose Wiles, senior research fellow, ^d Jilly Ward, research nurse, ^e Julia I Brooking, director of research, ^b for the Southampton NLU Evaluation Team.

^a Departments of Geriatric Medicine and Social Work Studies, University of Southampton, Murray Building, Southampton SO17 1BJ, ^b School of Nursing and Midwifery, University of Southampton, ^c Medical Statistics Group, Health Care Research Unit, Southampton General Hospital, Southampton SO16 6YD, ^d School of Health Professions and Rehabilitation Sciences, University of Southampton, ^e Elderly Care Research Unit, University Department of Geriatric Medicine, Southampton General Hospital

Correspondence to: A Steiner, Department of Community Studies, University of California Santa Cruz, 1156 High Street, Santa Cruz, CA, USA 95064 steiner{at}cats.ucsc.edu

Objectives: 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.
Design: Randomised controlled trial with six month follow up.
Setting: 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.
Main outcome measures: Patients' length of stay, functional status, subsequent move to more dependent living arrangement.
Results: 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.
Conclusions: 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.

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Geriatricians should be involved in the management of older people in Intermediate Care

Ian Reeves
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