[Economic crisis: cost and effectiveness of short stay hospital units]. / En plena crisis económica: coste y efectividad de las unidades de estancia corta hospitalarias.

BACKGROUND: Length of stay is the main determinant of the cost of hospitalization, which is why strategies must be implemented to reduce conventional hospital stays while maintaining quality levels. Short Stay Units (SSU) were created with the aim of reducing hospital stays in a certain group of patients and pathologies. The aim of this paper is to evaluate the literature on the evidence of decreased length of stay, efficiency, readmissions in the emergency department, cost-effectiveness, and mortality of these units. METHODS: We made a systematic review of the literature, using the MeSH terms "Observation Unit", "Short-Stay Ward", "Monday to Friday Clinic" , "Monday to Friday Surgery Ward", "Short Stay Hospitalization", "Alternative to Conventional Hospitalization", "Alternative Admissions" in the MEDLINE database, Web of Knowledge and the Cochrane Library from January 1 1960 to January 1 2012. The studies reviewed were selected according to the U.S. Preventive Services Task Force Protocol. RESULTS: The SSU made it possible in certain groups of patients to reduce the period of stay and maintain efficiency, showing no increases in emergency readmissions or mortality. CONCLUSIONS: The SSU can be an instrument to reduce the cost of the health process in a certain group of pathologies.

[Informed consent: opinions of health care personnel from a teaching hospital]. / Consentimiento informado: opiniones del personal sanitario de un hospital universitario.

OBJECTIVE: To conduct a descriptive analysis of the opinions of health care personnel regarding different aspects related with the informed consent, and mainly the information given on informed consent forms. MATERIAL AND METHODS: All health care professionals (physicians, nurses and nursing auxiliaries) of a teaching hospital were invited to fill out an anonymous, 20-item questionnaire based on legal health guidelines. Degree of knowledge was assessed by age, professional and seniority status, speciality or position and bioethical background. RESULTS: The questionnaire was filled out by 277 participants, with a hospital participation of 67%. A total of 45.1% of the health care professionals believed they had insufficient information on what the informed consent consists of and when it should be completed by patients; 81.2% considered that informed consent is an instrument of professional protection against demands by the user; 62.8% thought that the information provided is not sufficiently clear to the patient; 76.2% that the reading and understanding are difficult for the average person and 37.9% considered that there is excessive information. Regarding the basic elements that should be included in the informed consent form, 96.7% advocate information, 93.5% comprehension, 84.1% willingness and 74% competence. A total of 98.9% of participants believed that side effects of a diagnostic or therapeutic intervention should be specified in the document, 57% the likelihood of success and 70.8% alternatives. Furthermore, 59.6% are not in favor of using numerical percentages to express procedure risks. CONCLUSIONS: Half of health-care professionals were unaware of what an informed consent consists of, its different sections, the law that regulates it and the philosophy underlying its development.