Quick Diagnosis Units-An Effective Alternative to Hospitalization for Diagnostic Workup: A Systematic Review

INTRODUCTIONThis era of healthcare reform emphasizes improving value of care. Inpatient admissions for diagnostic evaluation put economic pressure on an already strained healthcare system. We conducted a systematic review of effectiveness of quick diagnosis units (QDUs), an established outpatient model for early diagnostic workups in Europe. METHODSWe searched MEDLINE and Embase for studies that focused on implementation of quick/rapid diagnosis units, with relevant Medical Subject Headings terms and keywords. Of 2047 studies, we selected 13 for full-text screening and bibliography review. Of these, 5 studies included at least 2 primary outcomes of interest and were included in our review. These units functioned as outpatient clinics, staffed by internists, nurses, and clerical staff, with expedited scheduling of outpatient diagnostic tests. Our primary outcome measures were final diagnosis, the mean time to final diagnosis, inpatient bed-days saved per patient, and costs saved per patient. We also studied discharge disposition, care preferences, and safety data. RESULTSAbout 18% to 30% of patients were diagnosed with malignancy, with an average time to diagnosis of 6 to 11 days. Inpatient bed-days saved per patient ranged from 4.5 to 7. Savings from fixed costs of hospitalization ranged from $2336(Euro1764) to $3304(Euro2514) for each patient enrolled in the protocol. The QDU model was preferred by 88% of patients, and patient satisfaction rates were 95% to 97%. CONCLUSIONSQDUs seem an effective and cost-saving alternative to inpatient hospitalization, and appear to be a safe approach for diagnostic workup of potentially severe diseases in select patient populations, although there are limited safety data available. Journal of Hospital Medicine 2014;9:54-59. (c) 2013 Society of Hospital Medicine