The Short Stay Unit as a new option for hospitals: a review of the scientific literature.

BACKGROUND: The short stay unit (SSU) is a ward providing targeted care for patients requiring brief hospitalization and dischargeable as soon as clinical conditions are resolved. Therefore, SSU is an alternative to the ordinary ward (OW) for the treatment of selected patients. The SSU model has been tested in only a few hospitals, and the literature lacks systematic evaluation of the impact of SSU use. The aim of our study was to evaluate the use of SSUs in terms of length of hospital stay, mortality and readmission rate. MATERIAL/METHODS: A random effect meta-analysis was carried out by consulting electronic databases. Studies were selected that focused on comparison between use of SSUs and OWs. Mean difference of length of stay was calculated within 95% confidence intervals. RESULTS: Six articles were selected, for a total of 21 264 patients. The estimated mean difference was -3.06 days (95% CI -4.71, -1.40) in favor of the SSU. The selected articles did not show any differences in terms of mortality and readmission rate. CONCLUSIONS: Use of SSUs could reduce patient length of stay in hospital, representing an alternative to the ordinary ward for selected patients. A shorter period of hospitalization could reduce the risk of hospital-acquired infections, increase patient satisfaction and yield more efficient use of hospital beds. Findings of this study are useful for institutional, managerial and clinical decision-makers regarding the implementation of the SSU in a hospital setting, and for better management of continuity of care.

Decrease of methicillin resistant Staphylococcus aureus prevalence after introduction of a surgical antibiotic prophylaxis protocol in an Italian hospital.

The use of antimicrobials is an important factor contributing to the emergence of antibiotic resistance. The goal of our study was to evaluate the impact of the introduction of an antibiotic surgical prophylaxis protocol on the prevalence of methicillin resistant Staphylococcus aureus (MRSA) infections in a tertiary care hospital. The protocol of surgical antibiotic prophylaxis was designed by a multidisciplinary team and was implemented in December 2001. Between January 2002 and December 2002, pharmacy, laboratory and active surveillance-records were prospectively reviewed to calculate prevalence rates of defined daily doses (DDD), microorganism isolation and health-care related infections. A progressive decrease from 1.58 to 0.56 of MRSA isolations per 1000 patient-days and from 76.4% to 29.4% MRSA prevalence rate was reported (p<0.001). Monthly prevalence rates of MRSA showed a significant linear correlation with the reduction of the DDD of the 3rd generation cephalosporins (r=0.90; p<0.001). MRSA surgical site and blood stream infections decreased from 78% to 38% and from 89% to 38%, respectively (p=0.017 and p=0.026). In our experience, the reduction of 3rd generation cephalosporin use was an effective strategy to reduce the MRSA infection rate and was associated with the reduction of the overall expenditure for antibiotics in the hospital.