Quick outpatient diagnosis in small district or general tertiary hospitals

Abstract

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.

Quick diagnosis units: predictors of time to diagnosis and costs

“…The variables recorded were the same as reported elsewhere. [ 12 ] The information on the number and dates of the appointments at the QDU and the diagnostic tests as well as the reason for referral and the final diagnosis were obtained from the hospital electronic clinical records. The referral reason was dichotomized into clinical or paraclinical features suggestive of malignancy vs other referral reasons (see supplementary material) for statistical analyses purposes.…”

“…Over the last 15 years several QDUs have been set up in Catalonia as a mean of reaching diagnoses rapidly and without the problems and costs related to hospitalization [ 10 ] . There are QDUs in almost all types of hospitals, from university (like Hospital Clínic de Barcelona) [ 11 ] to small district ones (like Hospital Plató) [ 12 ] . Despite the spread of these QDUs, the available evidence on their activity and the predictors of their time-to-diagnosis and cost outcomes is scanty, particularly in the case of nonuniversity, nontertiary centers.…”

Diagnostic evaluation of patients with symptoms suggestive of cancer in a hospital ambulatory setting: Comparative analysis by micro‐costing of quick diagnosis clinics

“…The structure, indications for referral, and operating procedures of these units have been reported previously [6,10,14,15]. Briefly, they work as ambulatory clinics evaluating patients with suspected severe disorders whose general physical condition is acceptable enough to enable them to go to hospital for investigations and appointments, then back to home.…”

“…The unit is open 5 days a week [11,12]. In contrast, the unit of the secondary hospital is staffed with two part-time general internists as well as administrative personnel [10,15].…”

Trends in Hospitalization of Patients with Potentially Serious Diseases Evaluated at a Quick Diagnosis Clinic

“…Different, mainly observational studies revealed that these units were as clinically effective as inpatient admission to reach a diagnosis, with similar diagnostic times. While patient reported satisfaction was also similar or higher than conventional hospitalization, quick diagnosis units proved cost-effective with associated costs significantly lower than the same costs applied to the evaluation of the same conditions in the hospital setting [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ].…”