Northern Ireland Training Scheme, Belfast, Northern Ireland, UK.
Eur J Emerg Med. 2010 Apr;17(2):89-96. doi: 10.1097/MEJ.0b013e32832f05bf.
To evaluate a Clinical Decision Unit (CDU) designed to utilize alternatives to emergency hospitalization. CDUs are one model of care designed to strengthen the gatekeeper role of Emergency Departments (EDs).
This retrospective cohort study was carried out in a UK NHS acute hospital. All 854 patients in the CDU cohort were compared with three age-stratified, historical cohorts from the same clinical centre. The median age was 62 years (range 16-94).The main outcome measures were discharge to general practitioner, outpatient services or hospitalization, the 30-day unplanned reattendance rate for those not hospitalized, and monthly medical admission figures.
Approximately 511 [59.8%, 95% confidence interval (CI): 56.5-63.1%] to 560 (65.6%, 95% CI: 62.3-68.7%) patients were admitted in the comparison cohorts, compared with only 186 (21.8%, 95% CI: 19.1-24.7%) in the CDU cohort (P≤0.05). Approximately 243 (28.5%, 95% CI: 25.5-31.6%) to 289 (33.8%, 95% CI: 30.7-37.1%) patients were discharged to general practitioner services in the comparison groups, compared with 562 (65.8%, 95% CI: 62.6-68.9%) in the CDU group (P≤0.05). Approximately eight (0.9, 95% CI: 0.5-1.8%) to 17 (2%, 95% CI: 1.2-3.2%) patients in the comparison groups were discharged to outpatient clinics, compared with 82 (9.6%, 95% CI: 7.8-11.8%) in the CDU group (P≤0.05). There was no consistent trend towards statistically significant rises in unplanned reattendance (P>0.05). Monthly medical admissions fell substantially during CDU operation.
This CDU model was associated with statistically and clinically significant reductions in hospital admissions. The judicious application of this CDU model to other ED environments can be expected to yield similar benefits.
评估一种旨在利用替代急诊住院的临床决策单元（CDU）。CDU 是一种旨在加强急诊部门（ED）把关作用的护理模式。
本回顾性队列研究在英国国民保健制度的一家急症医院进行。将 CDU 队列中的 854 名患者与来自同一临床中心的三个年龄分层的历史队列进行比较。中位年龄为 62 岁（范围 16-94 岁）。主要结局指标为未住院患者的普通科医生、门诊服务或住院治疗出院率、30 天非计划性再就诊率以及每月医疗入院人数。
在比较队列中，约有 511[59.8%，95%置信区间（CI）：56.5-63.1%]至 560（65.6%，95%CI：62.3-68.7%）名患者被收治入院，而 CDU 队列中仅有 186（21.8%，95%CI：19.1-24.7%）名患者（P≤0.05）。在比较组中，约有 243（28.5%，95%CI：25.5-31.6%）至 289（33.8%，95%CI：30.7-37.1%）名患者出院至全科医生服务，而 CDU 组中有 562（65.8%，95%CI：62.6-68.9%）名患者（P≤0.05）。在比较组中，有 8（0.9，95%CI：0.5-1.8%）至 17（2%，95%CI：1.2-3.2%）名患者出院至门诊诊所，而 CDU 组中有 82（9.6%，95%CI：7.8-11.8%）名患者（P≤0.05）。无明显趋势表明非计划性再就诊率显著上升（P>0.05）。 CDU 运行期间，医疗入院人数大幅下降。
该 CDU 模式与住院人数的统计学和临床显著减少相关。在其他 ED 环境中谨慎应用这种 CDU 模式预计会产生类似的益处。
