The Special Care Unit: Improving the Experience of Seriously Ill Hospitalized Patients
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Objective Examine outcomes for hospitalized adults age 65 and older with advanced chronic obstructive pulmonary disease or heart failure admitted to either a Special Care Unit (SCU) or Intensive Care Unit (ICU) within an urban community hospital. Background Advanced chronic conditions when treated in the ICU versus a SCU can cause lengthy hospitalizations that reduce quality of life and increase costs. Theoretical Framework Donabedian’s Structure-Process-Outcome Conceptual Model Methods Retrospective descriptive chart review explored and compared differences in health care utilization, length of stay (LOS), and documented goals of care (GOC) and end-of-life (EOL) planning conversations within the two units. Outcomes were analyzed using independent sample t-test, chi-square and Fisher’s exact test. Results Eighty-eight percent of SCU patients had decreased utilization compared to 8% in the ICU (p<0.001). GOC and EOL documentation was statistically significant (p<0.001). Eight percent of ICU patients had documented EOL planning discussions compared to 100% in the SCU. The sample t-test was not statistically significant (t (48) = 1.4, p = 0.16), but SCU LOS was higher. Conclusion The redirection of resources from an ICU setting to a more appropriate environment could be beneficial in improving quality of care and lead to improved outcomes and reduce costs.