Effectiveness and safety of an emergency department short-stay unit as an alternative to standard inpatient hospitalisation

Background: Emergency department short-stay units (EDSSUs) are currently emerging worldwide as an alternative to standard inpatient hospitalisation. In our hospital, a 960-bed teaching tertiary institution in Barcelona, Spain, an EDSSU has been in operation during winter periods ( November - March) since 1997. Aim: To determine the efficacy and safety of our EDSSU. Methods: Retrospective analysis of activity and quality outcomes, assessment of patient satisfaction levels and determination of the diagnostic-related groups that were mainly responsible for admissions to the EDSSU, comparing the clinical characteristics of those patients with the characteristics of patients with similar clinical diagnoses admitted to standard hospitalisation units. Results: 5666 patients were treated in the EDSSU, with a progressive increase in the number of patients admitted per period, ranging from 707 in 1997 - 8 to 1227 in 2003 - 4 ( 73.5% increase). The mean length of stay ranged from 3.1 to 2.8 days, mortality from 2.5% to 5.1%, home discharge rate from 84% to 90%, and hospital readmission rate within the first week after discharge from 3.9% to 6.2%. In all, 98% of patients were satisfied with their stay at the EDSSU. The main diagnostic-related groups were chronic obstructive pulmonary disease ( COPD = 50%) and acute heart failure (28%). Patients with COPD admitted at the EDSSU ( n = 545) showed significantly ( p = 0.05) lower mean length of stay (3.4 v 12 days) and mortality ( 1.7% v 8.1%), but a higher hospital readmission rate (9.9% v 7%) than those admitted to standard inpatient units ( n = 1961). Conclusions: In our experience, the EDSSU proved to be an effective and safe alternative to standard inpatient hospitalisation.