The effectiveness of intermediate care in a nursing-led in-patient unit

In order to assess the potential for a nursing-led in-patient unit (NLIU) t o substitute for a period of care in the acute hospital environment and pro mote recovery before discharge, a randomised controlled trial was conducted . The setting was an acute inner London hospital trust, part of the UK's na tional 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). Pat ients were identified as medically stable but in need of additional nursing intervention by referring medical staff prior to full nursing assessment o f suitability. Outcomes compared included functional dependence (Barthel In dex), discharge destination and length of hospital stay. Inputs from nursin g, paramedical and medical staff were measured. There was no significant di fference in functional independence at discharge (p > 0.05). Patients under going 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 r ecruitment (23% NLIU, 24% usual care p > 0.05) due tore-admissions. The mod el of care implemented differed considerably from that described in the lit erature with the NLIU having significantly fewer qualified nurses (RNs). Al though the anticipated benefits of the NLIU were not demonstrated, the stud y does not conclude that the model should be rejected. Factors driving leng th of stay need to be further investigated, as does the possibility of post -discharge benefits. The NLIU does offer some potential to substitute for a cute care but also appears to substitute for a period of primary care. (C) 2000 Elsevier Science Ltd. All rights reserved.