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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Medicine is changing; a necessity given the various economic crises that have affected healthcare systems; the pandemic which has upended the traditional way of managing and organizing healthcare, and even more so in hospitals; and trends that advocate for focusing attention on patients, humanizing their care, and involving them in decisions about their health. Therefore, the search for and implementation of alternatives to conventional hospitalization as efficient forms of management has accelerated.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first initiatives in Spain arose in surgery departments in the 1980s, with the creation of major ambulatory surgery units. Later, they arose in the rest of disciplines with the creation of day hospitals, home hospitalization (HH), short-stay units (SSU), or rapid-resolution units, among others.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The main characteristics are that they provide an adequate diagnosis and treatment for the patient with a careful selection of diseases, procedures, and clinical symptoms cared for in these units, without increasing adverse events. This means that, compared to traditional care, they must maintain the same safety and outcome indicators and offer improvements in other important aspects, such as reductions in length of hospital stay, infections, and costs; improvements in patient satisfaction; and improved efficiency in the use of beds than the remaining hospital departments.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the case of SSUs, numerous studies support their safety and effectiveness and in all of them, an adequate patient selection is fundamental to achieving the improvements expected.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> However, their implementation in Spain remains scarce.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The RECIGE project (2012) conducted a survey of 591 Spanish hospitals and found that only 11.3% of them had an SSU and that 65% of those SSUs were dependent on the emergency department and 23% on the internal medicine department.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Secondly, upon analyzing data on 40 SSUs, it was observed that the diseases most often cared for in these units were exacerbations of chronic cardiac and respiratory diseases.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Heart failure is the epidemic of the 21st century. Beyond the data on its incidence and prevalence in the population, its importance lies in the fact that acute heart failure (AHF) decompensation is one of the diseases that causes the most emergency department visits, hospital stays, and clinic visits, leading to a significant use of both human and financial resources and—no less important—of hospital beds. It must be considered that these are older patients who have a high number of comorbidities and that between 70% and 80% of them end up being hospitalized after being attended to in the emergency department.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Therefore, it is necessary to search for more efficient alternatives which provide more benefits to patients with AHF. The consensus document on the improvement of comprehensive care of patients with AHF by the Spanish Society of Cardiology, the Spanish Society of Internal Medicine, and Spanish Society of Emergency Medicine already includes SSUs among the alternative hospital units to conventional hospitalization where patients with AHF can be referred and indicates the clinical criteria which must be met to be treated in said units.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">SSUs are proposed as an efficient, safe alternative to conventional hospitalization, but some analyses of SSUs attribute part of their benefits, especially the improvements in mean length of hospital stay, to the patient selection necessary to be admitted to the unit and raise questions about whether this would worsen the rest of the hospital's figures. In this regard, a 2017 study by Richard Espiga et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> demonstrated that the creation of an SSU in their hospital decreased the mean stay in the hospital as a whole and the medical departments without increasing adverse events compared to hospitalizations in the same hospital prior to its creation.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study by Sánchez-Marcos et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> goes a step further because, while maintaining patient safety (measured by the usual indicators for ACH: 30-day mortality, repeat visits to the emergency department, and readmissions), they show a decline of four days in the mean stay of patients hospitalized due to AHF in SSUs regardless of the patient selection necessary for admission to said unit.</p><p id="par0050" class="elsevierStylePara elsevierViewall">They analyzed not only patients hospitalized in SSUs versus patients in conventional hospitalization, but also paired patients with the same clinical characteristics using severity scales (MEESSI scale) and propensity score matching with the analysis of various clinical and analytical variables; thus, they compared patients with the same level of severity and clinical characteristics. The authors concluded that SSUs are a safe and effective alternative for selected patients with AHF and, therefore, policies should be established that incorporate SSUs into our centers.</p></span>"
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