A quick diagnosis unit as an alternative to conventional hospitalization in a tertiary public hospital: a descriptive study

Sanclemente-Ansó, Carmen; Salazar, Albert; Bosch, Xavier; Capdevila, Cristina; Vallano, Antonio; Català, Isabel; Fernandez-Alarza, Antonio F; Rosón, Beatriz; Corbella, Xavier

doi:10.20452/pamw.1966

Cited by 10 publications

(13 citation statements)

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“…[24,28] Furthermore, although patients evaluated in QDU1 required less visits to be diagnosed, the time-to-diagnosis was significantly longer than in QDU2, a finding related to the unavailability of administrative staff in the former (see below). Although the frequency of cancer as a final diagnosis in the 2 units is consistent with former reports, [21,22,24,26,31] its significantly higher occurrence in QDU2 than in QDU1 patients is mostly justified by the considerably higher rate of digestive malignancies (mainly colorectal and pancreatic cancer) among patients presenting with gastrointestinal symptoms (24% in QDU2 vs 2% in QDU1) (data not shown).…”

Section: Discussionsupporting

confidence: 90%

“…Although several characteristics of the functioning and outcomes of QDU1 and the patients evaluated at it are not substantially different from those reported in other QDUs, [19,24,26,31] a key difference lies in the resources the unit at the district hospital has. While the unit of the reference hospital has an attending physician full-time and administrative and nursing staff to arrange appointments and deliver healthcare nursing work, respectively, [24] QDU1 has an attending physician part-time but neither administrative nor nursing staff of its own.…”

Section: Discussionmentioning

confidence: 88%

“…Reported studies include descriptive, single-center studies [26,31,32] and studies comparing QDUs with traditional admission for workup. [22–27] Overall, results from these studies conclude that the 2 settings are similarly operative in reaching a timely diagnosis but that QDU savings from hospitalization are striking.…”

Section: Discussionmentioning

confidence: 99%

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Quick outpatient diagnosis in small district or general tertiary hospitals

et al. 2017

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While quick diagnosis units (QDUs) have expanded as an innovative cost-effective alternative to admission for workup, studies investigating how QDUs compare are lacking. This study aimed to comparatively describe the diagnostic performance of the QDU of an urban district hospital and the QDU of its reference general hospital.This was an observational descriptive study of 336 consecutive outpatients aged ≥18 years referred to the QDU of a urban district hospital in Barcelona (QDU1) during 2009 to 2016 for evaluation of suspected severe conditions whose physical performance allowed them to travel from home to hospital and back for visits and examinations. For comparison purposes, 530 randomly selected outpatients aged ≥18 years referred to the QDU of the reference tertiary hospital (QDU2), also in Barcelona, were included. Clinical and QDU variables were analyzed and compared.Mean age and sex were similar (61.97 (19.93) years and 55% of females in QDU1 vs 60.0 (18.81) years and 52% of females in QDU2; P values = .14 and .10, respectively). Primary care was the main referral source in QDU1 (69%) and the emergency department in QDU2 (59%). Predominant referral reasons in QDU1 and 2 were unintentional weight loss (UWL) (21 and 16%), anemia (14 and 21%), adenopathies and/or palpable masses (10 and 11%), and gastrointestinal symptoms (10 and 19%). Time-to-diagnosis was longer in QDU1 than 2 (12 [1–28] vs 8 [4–14] days; P < .001). Malignancy was more common in QDU2 than 1 (19 vs 13%; P = .001). Patients from both groups with malignancy, aged ≥65 years and requiring >2 visits to be diagnosed were in general more likely to be males, to have UWL and adenopathies and/or palpable masses but less likely anemia, to undergo more examinations except endoscopy, and to be referred onward to specialist outpatient clinics.Despite some differences, results showed that, for diagnostic purposes, the overall performance and effectiveness of QDUs of urban district and reference general hospitals in evaluating patients with potentially serious conditions were similar. This study, the first to compare the performance of 2 hospital-based QDUs, adds evidence to the opportunity of producing standardized guidelines to optimize QDUs infrastructure, functioning, and efficiency.

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confidence: 90%

Section: Discussionmentioning

confidence: 88%

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Quick outpatient diagnosis in small district or general tertiary hospitals

et al. 2017

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“…Whilst inappropriate use of hospital beds surpasses 20% through diverse specialties in Europe, admission for workup is one of the commonest reasons for inappropriate hospitalizations [28,29]. Deficiencies at several levels of the Spanish healthcare system prompted the creation of alternatives to hospitalization, exemplified by hospital-based outpatients’ quick diagnosis units (OQDUs) [23,25,30–33]. Reported advantages over hospitalization are numerous: besides ensuring a time-to-diagnosis similar to the length-of-stay for the same evaluable condition, these clinics decrease emergency department referrals from primary healthcare centers and ease overcrowding, are associated with higher scores of patient reported satisfaction than inpatients, and are significantly cost-saving [31,34–42].…”

Section: Introductionmentioning

confidence: 99%

Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients

et al. 2017

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BackgroundWhereas there are numerous studies on unintentional weight loss (UWL), these have been limited by small sample sizes, short or variable follow‐up, and focus on older patients. Although some case series have revealed that malignancies escaping early detection and uncovered subsequently are exceptional, reported follow-ups have been too short or unspecified and necropsies seldom made. Our objective was to examine the etiologies, characteristics, and long-term outcome of UWL in a large cohort of outpatients.MethodsWe prospectively enrolled patients referred to an outpatient diagnosis unit for evaluation of UWL as a dominant or isolated feature of disease. Eligible patients underwent a standard baseline evaluation with laboratory tests and chest X-ray. Patients without identifiable causes 6 months after presentation underwent a systematic follow-up lasting for 60 further months. Subjects aged ≥65 years without initially recognizable causes underwent an oral cavity examination, a videofluoroscopy or swallowing study, and a depression and cognitive assessment.ResultsOverall, 2677 patients (mean age, 64.4 [14.7] years; 51% males) were included. Predominant etiologies were digestive organic disorders (nonmalignant in 17% and malignant in 16%). Psychosocial disorders explained 16% of cases. Oral disorders were second to nonhematologic malignancies as cause of UWL in patients aged ≥65 years. Although 375 (14%) patients were initially diagnosed with unexplained UWL, malignancies were detected in only 19 (5%) within the first 28 months after referral. Diagnosis was established at autopsy in 14 cases.ConclusionThis investigation provides new information on the relevance of follow-up in the long-term clinical outcome of patients with unexplained UWL and on the role of age on this entity. Although unexplained UWL seldom constitutes a short-term medical alert, malignancies may be undetectable until death. Therefore, these patients should be followed up regularly (eg yearly visits) for longer than reported periods, and autopsies pursued when facing unsolved deaths.

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“…Por otro lado, con el fin de aminorar los tiempos desde el momento de la sospecha al diagnóstico y tratamiento definitivo, es preciso comentar que cada vez más centros hospitalarios disponen de unidades, por lo general vinculadas a los SUH, como la Unidad de Corta Estancia, que se han convertido en áreas de alta resolución de procesos como la descompensación de patologías [5][6][7][8] . En este sentido, son responsables de la atención de ciertos síndromes como la neumonía, la enfermedad pulmonar obstructiva crónica descompensada, la hemoptisis, la hematuria, la lumbalgia, el prurito, la hemorragia digestiva alta y baja o las alteraciones del ritmo intestinal, que son frecuentemente la forma de presentación de patología oncoló-gica y por tanto donde se puede realizar un diagnóstico etiológico precoz 9,10 .…”

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Diagnóstico de sospecha de cáncer en los servicios de urgencias

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et al. 2015

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Hemos leído con especial interés el artículo publicado por Lana y col sobre el diagnóstico de sospecha de cáncer en la población de Asturias. En dicho trabajo se documenta que casi un 8% de los diagnós-ticos de cáncer se lleva a cabo en los servicios de Urgencias Hospitalarios (SUH). Además, cuando se compara el diagnóstico realizado en SUH frente al resto de servicios, destaca que las localizaciones más frecuentes son pulmón, aparato digestivo o sistema nervioso central, que existe mayor probabilidad de estar en fase avanzada, y sobre todo, la más rápida gestión del proceso diagnóstico 1 . A pesar de las limitaciones sobre el lugar del estudio y la posible validez de los resultados a la hora de extrapolarlos al resto de comunidades autónomas, creemos que el presente trabajo aporta importantes conclusiones sobre el diagnóstico del cáncer poblacional y que merece la pena realizar una serie de reflexiones sobre el posible rol de los SUH.Es indiscutible que la Atención Primaria juega y tiene que seguir jugando un papel clave como primer eslabón de la cadena en el diagnóstico precoz de las patologías oncológicas mediante los exámenes perió-dicos de salud y las estrategias de despistaje en los grupos de riesgo. Esto no excluye que, dada la alta probabilidad de contacto con el sistema sanitario a través de los SUH (16,2 millones de visitas anuales) y la mayor frecuencia de cáncer en pacientes atendidos en urgencias por ciertos síndromes, se aproveche dicha oportunidad para realizar estrategias poblacionales y campañas de concienciación para potenciar el despistaje de ciertos tipos de cáncer 2,3 . Este tipo de estrategias de salud pública, es decir, utilizar cualquier tipo de contacto sanitario e incluso urgente para canalizar el despistaje de enfermedades potencialmente graves, se ha empezado a realizar con buenos resultados en patología infectocontagiosa como el VIH 4 . En este sentido, y con el fin de ayudar a disminuir el tiempo entre el primer síntoma y la sospecha diagnóstica, creemos que los médicos de urgencias deben estar correctamente formados sobre la identificación de factores de riesgo y las situaciones clínicas donde se debe recomendar el despistaje de cáncer así como el disponer de los circuitos asistenciales para llevar a cabo un diagnóstico precoz en los grupos poblacionales de alto riesgo.Por otro lado, con el fin de aminorar los tiempos desde el momento de la sospecha al diagnóstico y tratamiento definitivo, es preciso comentar que cada vez más centros hospitalarios disponen de unidades, por lo general vinculadas a los SUH, como la Unidad de Corta Estancia, que se han convertido en áreas de alta resolución de procesos como la descompensación de patologías

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A quick diagnosis unit as an alternative to conventional hospitalization in a tertiary public hospital: a descriptive study

Cited by 10 publications

References 5 publications

Quick outpatient diagnosis in small district or general tertiary hospitals

Quick outpatient diagnosis in small district or general tertiary hospitals

Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients

Diagnóstico de sospecha de cáncer en los servicios de urgencias

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