Galipeau James, Pussegoda Kusala, Stevens Adrienne, Brehaut Jamie C, Curran Janet, Forster Alan J, Tierney Michael, Kwok Edmund S H, Worthington James R, Campbell Samuel G, Moher David
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
The Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Acad Emerg Med. 2015 Aug;22(8):893-907. doi: 10.1111/acem.12730. Epub 2015 Jul 22.
Overcrowding is a serious and ongoing challenge in Canadian hospital emergency departments (EDs) that has been shown to have negative consequences for patient outcomes. The American College of Emergency Physicians recommends observation/short-stay units as a possible solution to alleviate this problem. However, the most recent systematic review assessing short-stay units shows that there is limited synthesized evidence to support this recommendation; it is over a decade old and has important methodologic limitations. The aim of this study was to conduct a more methodologically rigorous systematic review to update the evidence on the effectiveness and safety of short-stay units, compared with usual care, on hospital and patient outcomes.
A literature search was conducted using MEDLINE, the Cochrane Library, Embase, ABI/INFOM, and EconLit databases and gray literature sources. Randomized controlled trials of ED short-stay units (stay of 72 hours or less) were compared with usual care (i.e., not provided in a short-stay unit), for adult patients. Risk-of-bias assessments were conducted. Important decision-making (gradable) outcomes were patient outcomes, quality of care, utilization of and access to services, resource use, health system-related outcomes, economic outcomes, and adverse events.
Ten reports of five studies were included, all of which compared short-stay units with inpatient care. Studies had small sample sizes and were collectively at a moderate risk of bias. Most outcomes were only reported by one study and the remaining outcomes were reported by two to four studies. No deaths were reported. Three of the four included studies reporting length of stay found a significant reduction among short-stay unit patients, and one of the two studies reporting readmission rates found a significantly lower rate for short-stay unit patients. All four economic evaluations indicated that short-stay units were a cost-saving intervention compared to inpatient care from both hospital and health care system perspectives. Results were mixed for outcomes related to quality of care and patient satisfaction.
Insufficient evidence exists to make conclusions regarding the effectiveness and safety of short-stay units, compared with inpatient care.
在加拿大医院急诊科，过度拥挤是一个严峻且持续存在的挑战，已证明这对患者预后有负面影响。美国急诊医师学会建议设立观察/短期住院单元作为缓解该问题的一个可能解决方案。然而，最近一项评估短期住院单元的系统评价表明，支持这一建议的综合证据有限；该评价距今已有十多年，存在重要的方法学局限性。本研究的目的是进行一项方法学上更严谨的系统评价，以更新关于短期住院单元与常规护理相比在医院和患者结局方面的有效性和安全性的证据。
使用MEDLINE、Cochrane图书馆、Embase、ABI/INFOM和EconLit数据库以及灰色文献来源进行文献检索。将急诊科短期住院单元（住院72小时或更短时间）的随机对照试验与成年患者的常规护理（即不在短期住院单元接受护理）进行比较。进行了偏倚风险评估。重要的决策（可分级）结局包括患者结局、护理质量、服务利用和可及性、资源使用、与卫生系统相关的结局、经济结局以及不良事件。
纳入了五项研究的十份报告，所有这些研究都将短期住院单元与住院护理进行了比较。研究样本量较小，总体存在中度偏倚风险。大多数结局仅在一项研究中报告，其余结局在两至四项研究中报告。未报告死亡情况。四项纳入研究中有三项报告住院时间，发现短期住院单元患者的住院时间显著缩短，两项报告再入院率中的一项发现短期住院单元患者的再入院率显著较低。所有四项经济评估均表明，从医院和卫生保健系统角度来看，与住院护理相比，短期住院单元是一种节省成本的干预措施。与护理质量和患者满意度相关的结局结果不一。
与住院护理相比，关于短期住院单元的有效性和安全性，现有证据不足，无法得出结论。
