Emergency department short-stay ward at a tertiary care hospital: 4 years’ experience

González Armengol JJ, Fernández Alonso C, Martín-Sánchez FJ, González Del Castillo J, López Farré A, Elvira C, Calvoa E, Villarroel Elipe P

Objective: A short-stay ward belonging to an emergency department and operating 24

hours a day, 7 days a week offers an alternative to conventional hospitalization. We

describe activity in the emergency department short-stay ward (16 beds) at Hospital

Clínico San Carlos in Madrid, Spain.

Methods: Descriptive study of all short-stay emergency admissions for the years 2003

through 2006. Information was obtained retrospectively from case records and

discharge summaries.

Results: A total of 10 942 admissions to the ward, representing 13.2% of all hospital

admissions from the emergency department, were included. The mean (SD) age was

78.8 (18.5) years and 62.5% of the patients were female. The occupancy rate was 87%

(mean number of beds occupied, 14.6 [1.5]). The main reasons for admission to the

short-stay ward were the exacerbation of chronic conditions (heart failure and chronic

obstructive pulmonary disease), infections (of the respiratory and urinary tracts),

syncope, arrhythmia, diarrhea, gastrointestinal bleeding, and bowel obstruction. The

main diagnosis-related groups (DRGs) were 127, 541, and 321; 20 DRGs accounted for

55% of admissions. A mean of 1.18 (0.02) admissions per DRG were made, and the

mean duration of stay in the unit was 0.91 (1.39) days. In 9811 cases (89.7%) the

destination on discharge was outside hospital (20.10% of discharges were on a Saturday

or Sunday); 2638 discharged patients (26.9%) were given appointments for outpatient

visits, 1218 (12.4%) were placed in home hospitalization programs, and 293 (3.0% were

transferred to support facilities. Discharges home, outpatient appointments, and

transfers to support facilities increased significantly from year to year. A total of 1116

patients (10.9%) were transferred to another department of the hospital, 368 (32.98%)

after a new diagnosis. The remaining internal transfers were due to lack of improvement

in the condition for which the patient had been admitted. The rate of new diagnoses

made while the patient was in the short-stay ward increased significantly over the period

studied (P < .001). The mortality rate was 0.14% and the readmission rate, 3.7%. Conclusions: The emergency department short-stay ward offers an alternative to conventional hospitalization. The diagnostic and therapeutic efficiency of this care model is high.

Calvoa E, Elvira C, Fernández-Alonso C, González Armengol JJ, González Del Castillo J, López Farré A, Martín-Sánchez FJ, Villarroel Elipe P