australian journal of advanced nursing

INTRODUCTION
The concept of the short stay unit (SSU) was
initially introduced into surgical services targeting
minor surgical procedures that required admission
(Marshall and Cregan 2005). This was to expedite the
discharge process thereby addressing the pressure
for beds, avoiding postponement of other elective
procedures and ultimately costs. Cregan (2005)
and Khan et al (1997) alluded to an increase in
consumer demand and bed blocking as reasons
contributing to the pressure for beds. Currently the
public health system is experiencing an increase in
demand for services that is not being met owing to
budget restrictions, thus leading to ‘bed blocking’.
The concept of a SSU was gradually introduced
into other specialties, notably emergency medicine
(Khan et all 1997 and Goodacre 1998). The success
was variable and consistent data describing cost
effectiveness and acceptable clinical satisfaction
was lacking (Goodacre 1998). In 2000, this concept
was trialled in Sydney in paediatrics with success
(Browne 2000). In the same year, a medical short
stay unit established in Montreal in 1989 was
reviewed. The review recommended further research
into cost‑effectiveness, to compare definitively the
efficiency and outcomes of care delivered to similar
patients in the medical short stay unit within the
traditional medical inpatient units and to assess the
impact of a staff‑run medical short stay unit on the
training experience of medical students and residents
(Abenheim et al 2000). Recently, the department of
health has recommended the introduction of SSU to
cardiology services attached to all tertiary hospitals
with cardiac catheterisation facilities in New South
Wales. Through the Clinical Services Redesign
Program, NSW Health is developing new models of
care for adult acute cardiology patients. The program
supports clinicians and managers to redesign and
improve a range of patient journeys across multiple
care centres in area health services. The objectives of
the State‑wide Cardiology Project are to enable timely
and equitable access to effective and appropriate
care across New South Wales, treat patients in order
of clinical priority, reduce variations in the length of
RESEARCH PAPER
stay for patients between and within facilities and
enable access by health service teams to a practical
and coordinated cardiology service for their patients.
One of the four projects developed, the Bed Solutions
Project aims to optimise catheterisation laboratory
throughput by utilising 23 hour‑beds (NSW Health
2007a and NSW Health 2007b). This study seeks to
assess the impact and success of this intervention
from the perspective of the staff working within the
SSU. It has the potential to highlight the need for
clinical redesign of the SSU.
METHODS
This pilot study conducted at tertiary referral hospital
evaluated the SSU attached to a busy cardiovascular
unit with respect to staff perceptions about length
of stay, appropriateness of stay and the procedures
requiring admission, the discharge process, transfer
of medical information and workplace satisfaction.
We also invited the participants to include additional
comments. In addition, we also reviewed all the
admissions, adverse events and outcomes since the
introduction of the SSU in January 2007. We did not
survey patients as this was primarily a clinical, not
a quality control audit; as such, ethics committee
approval was not required.
With the agreement of the service and/or clinical
leaders and the team leaders, anonymous
self‑addressed envelopes containing a questionnaire
developed by the investigators (Appendix A) were
posted to all cardiologists (including visiting medical
officers [VMO]), cardiology fellows, cardiology
advanced trainees and nurses who worked in the
cardiac catheterisation laboratory (CCL), coronary
care unit (CCU), general cardiology ward (GCW) and
the short stay unit (SSU).
The questions covered a varied dimension of issues
that were considered important for the successful
operation of the SSU. The questions were each
rated with a response indicating a poor (rating=1)
to a good performance (rating=5). A level of ‘3’ is
considered satisfactory. Answers were dichotomized,
where all responses scoring 3‑5 were ‘favourable’
and those responses scoring 1‑2 were ‘unfavourable’.
AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 26 Number 4 24