First four years of operation of a municipal acute bed unit in rural Norway

Abstract

Objective: To evaluate the use of a small municipality acute bed unit (MAU) in rural Norway resulting from the Coordination reform regarding occupancy-rate, patient characteristics and healthcare provided during the first four years of operation. Further, to investigate whether implementation of the new municipal service avoided acute hospital admissions.

Design: Observational study.

Setting: A two-bed municipal acute bed unit.

Subjects: All patients admitted to the unit between 2013 and 2016.

Main outcome measures: Demographics, comorbidity, main diagnoses and level of municipal care on admission and discharge, diagnostic and therapeutic initiatives, MAU occupancy rate, and acute hospital admission rate.

Results: Altogether, 389 admissions occurred, 215 first-time admissions and 174 readmissions. The mean MAU bed occupancy rate doubled from of 0.26 in 2013 to 0.50 in 2016, while acute hospital admission rates declined. The patients (median age 84.0 years, 48.9% women at first time admission) were most commonly admitted for infections (28.0%), observation (22.1%) or musculoskeletal symptoms (16.2%). Some 52.7% of the patients admitted from home were discharged to a higher care level; musculoskeletal problems as admission diagnosis predicted this (RR =1.43, 95% CI 1.20–1.71, adjusted for age and sex).

Conclusion: Admission rates to MAU increased during the first years of operation. In the same period, there was a reduction in acute hospital admissions. Patient selection was largely in accordance with national and local criteria, including observational stays. Half the patients admitted from home were discharged to nursing home, suggesting that the unit was used as pathway to a higher municipal care level.

Key Points

• Evaluation of the first four years of operation of a municipality acute bed unit (MAU) in rural Norway revealed:

• • Admission rates to MAU increased, timely coinciding with decreased acute admission rates to hospital medical wards.

• • Most patients were old and had complex health problems.

• • Only half the patients were discharged back home; musculoskeletal symptoms were associated with discharge to a higher care level.

Keywords:

• Emergencies
• intermediate care facilities
• primary care
• hospitals
• community
• Norway

Acknowledgements

The authors thank Henriette Sandvik who has extracted data for this study from patients’ medical record.

Ethical approval

The Regional Committee for Medical and Health Research Ethics approved the study (ref. 2017/630).

Disclosure statement

The first author (AKS) was employed at the MAU during the study period. Since data collection was conducted retrospectively, this had no impact on the study. No potential conflict of interest was reported by the other authors.

Additional information

Funding

This study was funded by a grant from the Norwegian Medical Association (AFU-grant in 2017).