Unidad de diagnóstico rápido: un modelo asistencial eficaz y eficiente. Experiencia de 5 años

Capell, Santiago; Comas, P.; Piella, Teresa; Rigau, Joaquim; Pruna, Xavier; Martínez, Francesc; Montull, Santiago

doi:10.1016/s0025-7753(04)74478-4

Cited by 38 publications

(24 citation statements)

References 5 publications

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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%

“…Its results were reported in 2004 in a Spanish medical journal. [26] A subsequent study published in 2009 in an international medical journal about the experience of the Hospital of Granollers QDU and the general tertiary Hospital Clínic of Barcelona QDU revealed a similar diagnostic effectiveness, markedly lower costs, and greater patient satisfaction scores compared with traditional admission for the same evaluable disorders. [19] Although numerous QDUs have emerged during the last 15 years in several hospitals including general tertiary centers such as the Hospital Clinic of Barcelona and the Hospital of Bellvitge and smaller community centers such as the Hospital of Granollers, no study has evaluated how QDUs compare between them.…”

Section: Introductionmentioning

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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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Quick outpatient diagnosis in small district or general tertiary hospitals

et al. 2017

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“…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]. Malignancies constitute the most frequent diagnosis in Spanish OQDUs (18–30%) [35,42].…”

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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“…Studies show that anemia and cancer are the most-recorded diagnoses in Spanish QDU patients [4,5,27,28]. Likewise, the main reasons for hospitalization for diagnostic tests in Spain are severe anemia and suspected cancer-related unintentional weight loss [4-6,27-29]. Anemia, with or without symptoms, with hemoglobin levels below 8–9 g/l, has traditionally been a criterion for admission in our hospital [4,6].…”

Section: Discussionmentioning

confidence: 99%

“…However, the unit received patients from 12 PHC centers and the population attended is representative of that of other Spanish QDU, according to published reports [27-29,31,32]. In addition, although the appropriateness of PHC referrals to QDU and ED was objectively assessed using a scoring system, the possibility of some perception bias cannot be excluded.…”

Section: Discussionmentioning

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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Unidad de diagnóstico rápido: un modelo asistencial eficaz y eficiente. Experiencia de 5 años

Cited by 38 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

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

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