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

Objectives To compare post-acute intermediate care in an inpatient nurse-le d unit with conventional post-acute care on general medical wards of an acu te 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 commun ity hospitals. Participants 238 patients accepted for admission to nurse-led unit. Interventions Care in nurse-led unit or usual pest-acute care. Main outcome measures Patients' length of stay, functional status, subsequent move to m ore 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 interv al 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 s tay (4.5 days longer (- 3.6 to 12.5)). No differences were observed in mort ality, functional status, or living arrangements at any time. Patients in t he nurse-led unit received significantly fewer minor medical investigations and, after controlling for length of stay, significantly fewer major revie ws, tests, or drug changes. Conclusions The nurse-led unit seemed to be a safe alternative to conventio nal management, but a full accounting of such units' place. in the local co ntinuum of care and the costs associated with acute hospitals managing post -acute patients is needed if nurse-led units are to become an effective par t of the government's recent commitment to intermediate care.