Bosch Xavier, Ladino Andrea, Moreno-Lozano Pedro, Jordán Anna, López-Soto Alfonso
Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Hospital Clínic, 08036 Barcelona, Spain.
Diagnostics (Basel). 2020 Aug 13;10(8):585. doi: 10.3390/diagnostics10080585.
Although quick diagnosis units (QDU) have become a cost-effective alternative to inpatient admission for diagnosis of potentially serious diseases, the rate of return hospitalizations among evaluated patients is unknown. This study examined the temporal trends in admissions of QDU patients through 15 years. Adult patients referred to QDU from 2004 to 2019 who were hospitalized between the first and last visit in the unit were eligible. Decisions about admissions were mainly based on the Appropriateness Evaluation Protocol and required independent validation by experienced clinicians using a customized tool. The final analysis included 825 patients. Patient characteristics and major reasons for admission were compared each year and linear trends were analyzed. Admission rates decreased from 7.2% in 2004-2005 to 4.3% in 2018-2019 ( < 0.0001). While a significant increasing trend was observed in the rate of admissions due to cancer-related complications (from 39.5% in 2004-2005 to 61.7% in 2018-2019; < 0.0001), those due to anemia-related complications and scheduled invasive procedures experienced a significant downward trend. A likely explanation for these declining trends was the relocation of the unit to a new daycare center in 2013-2014 with recovery rooms and armchairs for IV treatments. The facts of this study could help in the provision of anticipatory guidance for the optimal management of patients at risk of clinical complications.
尽管快速诊断单元(QDU)已成为诊断潜在严重疾病时比住院治疗更具成本效益的选择,但经评估患者的再次住院率尚不清楚。本研究调查了15年间QDU患者入院情况的时间趋势。纳入2004年至2019年间转诊至QDU且在该单元首次就诊和末次就诊期间住院的成年患者。入院决策主要基于适宜性评估方案,且需要经验丰富的临床医生使用定制工具进行独立验证。最终分析纳入了825例患者。每年比较患者特征和主要入院原因,并分析线性趋势。入院率从2004 - 2005年的7.2%降至2018 - 2019年的4.3%(<0.0001)。虽然因癌症相关并发症导致的入院率呈显著上升趋势(从2004 - 2005年的39.5%升至2018 - 2019年的61.7%;<0.0001),但因贫血相关并发症和预定侵入性操作导致的入院率呈显著下降趋势。这些下降趋势的一个可能解释是该单元于2013 - 2014年迁至一个新的日间护理中心,该中心设有恢复室和用于静脉治疗的扶手椅。本研究结果有助于为有临床并发症风险的患者提供最佳管理的前瞻性指导。