Quick diagnosis units: avoiding referrals from primary care to the ED and hospitalizations

Bosch, Xavier; Jordan, Anna; López‐Soto, Alfonso

doi:10.1016/j.ajem.2012.06.013

Cited by 29 publications

(80 citation statements)

References 20 publications

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“…11,16 In our study, 89.2% of the patients referred to the QDU met the pre--established referral criteria, which is slightly higher than the rate reported by other QDUs in our setting. 8,12 The remaining 10.8% of the patients who did not meet those criteria should probably have been evaluated by other health care modalities such as family physicians or specific multidisciplinary functional units (e.g., lung or breast units). If the first year of operation of the QDU, which could be considered a year of adaptation, is excluded from the analysis, the percentage rises to 93.3%.…”

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confidence: 99%

“…However, QDU dependent on internal medicine departments, such as that described in this study, seem only to have been introduced in Spain, according to studies on their efficacy. 7,8,12 While the differences between QDUs are explained by structural differences, frequent clinical presentations with nonspecific symptoms such as involuntary weight loss, anemia, and lymphadenopathy in generally healthy people with potentially serious illness suggest the need for outpatient study in QDU led by versatile internal medicine specialists. As a result of his or her broad perspective, the internist may be able to recognize the whole clinical scenario of each patient, while closely collaborating with specialists and allocating limited resources in a judicious and fair way.…”

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confidence: 99%

“…7, 8 Moreover, the QDU model has been shown to be efficacious in avoiding referrals from PHCs to the ED.…”

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confidence: 99%

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

Sanclemente-Ansó¹,

Salazar²,

Bosch³

et al. 2013

Polish Archives of Internal Medicine

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

Sanclemente-Ansó¹,

Salazar²,

Bosch³

et al. 2013

Polish Archives of Internal Medicine

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“…In the setting of an 865-bed tertiary hospital in Barcelona (Spain) attending a population of 540,000, the outpatient internal medicine QDU assesses patients with suspected serious disease processes who are well enough to attend several appointments for diagnostic tests and QDU visits; therefore, they should ideally be stable clinically, mentally and physically capable of attending such outpatient appointments, in order to undergo quick diagnostic examinations [5,6]. Patients with some pulmonary disorders such as lung nodes are normally evaluated by the respiratory disease day center, although QDU evaluation is not ruled out.…”

Section: Methodsmentioning

confidence: 99%

“…The delays involved in the diagnostic and referral process have led to a search for alternatives, most notably hospital-based quick diagnosis units (QDU) for patients with suspected serious disease such as anemia or cancer [4,5]. Besides avoiding hospitalizations and PHC referrals to ED [6], the QDU model has demonstrated equal efficacy, lower costs and greater patient satisfaction compared with conventional admissions [4-6]. …”

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confidence: 99%

Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study

et al. 2014

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BackgroundIn Spain, primary healthcare (PHC) referrals for diagnostic procedures are subject to long waiting-times, and physicians and patients often use the emergency department (ED) as a shortcut. We aimed to determine whether patients evaluated at a hospital outpatient quick diagnosis unit (QDU) who were referred to ED from 12 PHC centers could have been directly referred to QDU, thus avoiding ED visits. As a secondary objective, we determined the proportion of QDU patients who might have been evaluated in a less rapid, non-QDU setting.MethodsWe carried out a cross-sectional retrospective cohort study of patients with potentially serious conditions attended by the QDU from December 2007 to December 2012. We established 2 groups of patients: 1) patients referred from PHC to QDU (PHC-QDU group) and 2) patients referred from PHC to ED, then to QDU (PHC-ED-QDU group). Two observers assessed the appropriateness/inappropriateness of each referral using a scoring system. The interobserver agreement was assessed by calculating the kappa index. Multivariate logistic regression analysis was performed to identify the factors associated with the dependent variable ‘ED referral’.ResultsWe evaluated 1186 PHC-QDU and 1004 PHC-ED-QDU patients and estimated that 93.1% of PHC-ED-QDU patients might have been directly referred to QDU. In contrast, 96% of PHC-QDU patients were found to be appropriately referred to QDU first. The agreement for PHC-QDU referrals (PHC-QDU group) was rated as excellent (ϰ = 0.81), while it was rated as good for PHC-ED referrals (PHC-ED-QDU group) (ϰ = 0.75). The mean waiting-time for the first QDU visit was longer in PHC-QDU (4.8 days) than in PHC-ED-QDU (2.6 days) patients (P = .001). On multivariate analysis, anemia (OR 2.87, 95% CI 1.49–4.55, P < .001), rectorrhagia (OR 2.18, 95% CI 1.10–3.77, P = .01) and febrile syndrome (OR 2.53, 95% CI 1.33-4.12, P = .002) were independent factors associated with ED referral. Nearly one-fifth of all QDU patients were found who might have been evaluated in a less rapid, non-QDU setting.ConclusionsMost PHC-ED-QDU patients might have been directly referred to QDU from PHC, avoiding the inconvenience of the ED visit. A stricter definition of QDU evaluation criteria may be needed to improve and hasten PHC referrals.

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Quick diagnosis units—an effective alternative to hospitalization for diagnostic workup: A systematic review

Gupta

Sukhal

Agarwal

et al. 2013

Journal of Hospital Medicine

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INTRODUCTION This era of healthcare reform emphasizes improving value of care. Inpatient admissions for diagnostic evaluation put economic pressure on an already strained healthcare system. We conducted a systematic review of effectiveness of quick diagnosis units (QDUs), an established outpatient model for early diagnostic workups in Europe. METHODS We searched MEDLINE and Embase for studies that focused on implementation of quick/rapid diagnosis units, with relevant Medical Subject Headings terms and keywords. Of 2047 studies, we selected 13 for full‐text screening and bibliography review. Of these, 5 studies included at least 2 primary outcomes of interest and were included in our review. These units functioned as outpatient clinics, staffed by internists, nurses, and clerical staff, with expedited scheduling of outpatient diagnostic tests. Our primary outcome measures were final diagnosis, the mean time to final diagnosis, inpatient bed‐days saved per patient, and costs saved per patient. We also studied discharge disposition, care preferences, and safety data. RESULTS About 18% to 30% of patients were diagnosed with malignancy, with an average time to diagnosis of 6 to 11 days. Inpatient bed‐days saved per patient ranged from 4.5 to 7. Savings from fixed costs of hospitalization ranged from $2336(€1764) to $3304(€2514) for each patient enrolled in the protocol. The QDU model was preferred by 88% of patients, and patient satisfaction rates were 95% to 97%. CONCLUSIONS QDUs seem an effective and cost‐saving alternative to inpatient hospitalization, and appear to be a safe approach for diagnostic workup of potentially severe diseases in select patient populations, although there are limited safety data available. Journal of Hospital Medicine 2014;9:54–59. © 2013 Society of Hospital Medicine

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Quick diagnosis units: avoiding referrals from primary care to the ED and hospitalizations

Cited by 29 publications

References 20 publications

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

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

Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study

Quick diagnosis units—an effective alternative to hospitalization for diagnostic workup: A systematic review

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