Certain programs designed to keep patients out of the hospital are safe for some acute conditions, research shows.
Several methods designed to keep patients out of the hospital are safe, according to an analysis of 20 years of research.
Researchers from Massachusetts General Hospital in Boston looked at 22 review articles published between 1995 and 2016 on approaches for treating conditions commonly treated in an inpatient setting. The studies covered pulmonary embolism, deep venous thrombosis, pneumonia, chest pain, kidney stones, and symptoms of heart failure or emphysema.
The following alternative approaches to care were deemed safe, according to the analysis:
- Outpatient management after initial diagnosis: Use of this approach for several acute medical conditions produced no significant difference in mortality, disease-specific outcomes, or patient satisfaction compared with inpatient admission.
- Quick diagnostic units designed to rapidly diagnose serious conditions, such as certain cancers: The evidence was more limited but indicated low mortality rates and high patient satisfaction, the researchers reported.
- Programs that deliver inpatient-level care to patients treated in the emergency department or an outpatient clinic: A variety of acute medical conditions had mortality rates, disease-specific outcomes, and patient and caregiver satisfaction that were either improved or no different compared with inpatient admission, the researchers stated. The exception was chronic obstructive pulmonary disease, where alternative programs did not increase patient satisfaction.
- The use of observation units within hospitals for 24 to 48 hours with outpatient follow-up: For asthma, chest pain, and atrial fibrillation, there was no difference in mortality, shorter lengths of stay, and better patient satisfaction compared to inpatient admissionst. Results for some conditions were more limited, the researchers noted.
The analysis showed there are opportunities for safe and effective health system redesign to include alternative management strategies for certain acute medical conditions, "although further evaluation is required in some cases," they concluded.