Case study 2: Short Stay Units in the ER

Short Stay Units offer a place for patients to recover and get basic medical attention without checking into a formal hospital bed.

Question: What is the effectiveness and safety of short stay units in the emergency department?

Context

Emergency department (ED) overcrowding is a serious and ongoing issue for most hospitals. Short Stay Units have been proposed as a potential strategy to manage that overcrowding. In 2011, a Canadian hospital considering this approach request the Ottawa Hospital Research Institute  Knowledge to Action Program to conduct a rapid review on the safety and effectiveness of SSUs. 

Approach taken

This rapid review involved a search of four databases as well as the gray literature, and used two team members (one with methodological expertise and the other with ED clinical expertise) to screen the retrieved citations. 

Unlike the Personal Protective Equipment example, the literature was vast and complex and there was not enough time to extract and synthesize the breadth of diverse primary studies. Accordingly, the review employed the shortcuts of restricting the literature to systematic review evidence only (identified in published literature or in gray literature) and to only English studies published after the year 2000. 

The latter cut off was considered acceptable to stakeholders who wanted evidence representing contemporary ED practice. Finally, a single team member (rather than two) performed the tasks of data extraction, quality appraisal, and narrative synthesis.

Findings

The review was conducted in 4 weeks (January to February, 2011). The team screened 1,648 studies and included evidence from 4 systematic reviews published between 2003 and 2008. The synthesis suggested that Short Stay Units may lead to improved clinical outcomes and efficiency in healthcare, but there wasn’t enough research on the topic. Specifically, the highest quality evidence came from a systematic review that was almost a decade old at the time of the rapid review and included studies that lacked rigorous scientific design. 

The researchers presented the findings in an easy to read report that suggested the potential benefit of Short Stay Units for hospital overcrowding and provided recommendations for future primary research and an updated systematic review. 

Action

Because of this rapid review, the local hospital decided to invest in its own Short Stay Unit program. Researchers also published their rapid review findings as an academic paper in 2012 so that this local synthesis exercise could benefit other decision-makers who may have been contemplating the implementation of a Short Stay Unit. 

The rapid review justified the need for a more comprehensive and updated systematic review. The research team sought and obtained funding from the Canadian Institutes of Health Research, producing an updated and robust analysis of the evidence and an additional academic publication in 2015.