Could nurse-led care help to unblock NHS beds?

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

Transferring patients to a low technology unit, where nurses rather than doctors manage recuperation after acute illness, is a safe alternative to conventional care on a general medical ward, finds a study in this week's BMJ. This approach may also constitute an overall benefit for the NHS by unblocking beds in community hospitals.

Steiner and colleagues randomly referred patients to care on the nurse-led unit of Southampton University Hospitals Trust or to usual post-acute care in the hospital. Length of stay, patient function, and discharge to a more dependent living arrangement was evaluated after six months.

Length of stay was 14.3 days longer in the nurse-led unit than in general medical wards, but the difference dropped to 4.5 days and was no longer significant when transfers to community hospitals were taken into account. No differences were found in death, functional status, or living arrangements at any time.

Nurse-led units are safe and do not shift service demands from hospital to community, say the authors. Instead, they seem to unblock beds in community hospitals - an important finding, not reported elsewhere in the literature. If such units are to become an effective part of the government's recent commitment to intermediate care, assessment of local responsibilities along the full continuum of care will be needed, they conclude.

Contacts:

Andrea Steiner, Research Associate Professor, University of California, Santa Cruz, USA Email: steiner@cats.ucsc.edu

Bronagh Walsh, School of Nursing & Midwifery, University of Southampton, Southampton UK Email: B.M.Walsh@soton.ac.uk