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Improving continuity of care in an acute medical unit: initial outcomes.
QJM. 2008 Jul; 101(7):529-33.QJM

Abstract

BACKGROUND

The importance of acute medical units and their associated medical cover is stressed in current practice but there is a paucity of existing research to establish their impact on acute patient care.

AIM

To assess the impact of a new medical admission process and associated medical cover on patient length of stay (LOS), direct discharge rates (DDR) (for admissions <24 and 48 h), daily discharge and readmission rates (RR).

DESIGN

We performed a retrospective analysis of 3163 medical patients admitted before and after a ward was reconfigured to function as an acute medical unit (AMU), with a new on-call rota: 'consultant of the day' changing to 'consultant of the weekend', with aligned junior medical cover.

METHODS

All medical admissions were analysed over three 2-month periods: two periods prior to the new AMU process (October to November, 2005 and June to July, 2006), and one period after the changes (October to Nov, 2006) which were made in August 2006.

RESULTS

Average LOS was reduced from 8.6 and 9.3 for the two previous periods (June to July, 2006 and October to November, 2005) to 7.8 days for October to November, 2006, (P = 0.028). DDR for patients with a LOS under 24 and 48 h increased from 21.3% and 31.2% to 28.5% and 39.5%, respectively for both 24 h (P < 0.005) and 48 h LOS (P = 0.038). No significant difference in RR were observed (within 7 days) over the same periods. For admissions <48 h, the percentage of patients discharged increased for the Consultant-led teams (P < 0.006) before and after the new process. A statistically insignificant trend in relation to DDR was observed towards increased discharges over the weekend.

DISCUSSION

The change in AMU process has resulted in improved DDR and patient length of stay, with no adverse effects on RR.

Authors+Show Affiliations

Department of Medicine, Chelsea and Westminster Hospital, London.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18417499

Citation

St Noble, Victoria J., et al. "Improving Continuity of Care in an Acute Medical Unit: Initial Outcomes." QJM : Monthly Journal of the Association of Physicians, vol. 101, no. 7, 2008, pp. 529-33.
St Noble VJ, Davies G, Bell D. Improving continuity of care in an acute medical unit: initial outcomes. QJM. 2008;101(7):529-33.
St Noble, V. J., Davies, G., & Bell, D. (2008). Improving continuity of care in an acute medical unit: initial outcomes. QJM : Monthly Journal of the Association of Physicians, 101(7), 529-33. https://doi.org/10.1093/qjmed/hcn042
St Noble VJ, Davies G, Bell D. Improving Continuity of Care in an Acute Medical Unit: Initial Outcomes. QJM. 2008;101(7):529-33. PubMed PMID: 18417499.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improving continuity of care in an acute medical unit: initial outcomes. AU - St Noble,Victoria J, AU - Davies,Gary, AU - Bell,Derek, Y1 - 2008/04/15/ PY - 2008/4/18/pubmed PY - 2008/9/19/medline PY - 2008/4/18/entrez SP - 529 EP - 33 JF - QJM : monthly journal of the Association of Physicians JO - QJM VL - 101 IS - 7 N2 - BACKGROUND: The importance of acute medical units and their associated medical cover is stressed in current practice but there is a paucity of existing research to establish their impact on acute patient care. AIM: To assess the impact of a new medical admission process and associated medical cover on patient length of stay (LOS), direct discharge rates (DDR) (for admissions <24 and 48 h), daily discharge and readmission rates (RR). DESIGN: We performed a retrospective analysis of 3163 medical patients admitted before and after a ward was reconfigured to function as an acute medical unit (AMU), with a new on-call rota: 'consultant of the day' changing to 'consultant of the weekend', with aligned junior medical cover. METHODS: All medical admissions were analysed over three 2-month periods: two periods prior to the new AMU process (October to November, 2005 and June to July, 2006), and one period after the changes (October to Nov, 2006) which were made in August 2006. RESULTS: Average LOS was reduced from 8.6 and 9.3 for the two previous periods (June to July, 2006 and October to November, 2005) to 7.8 days for October to November, 2006, (P = 0.028). DDR for patients with a LOS under 24 and 48 h increased from 21.3% and 31.2% to 28.5% and 39.5%, respectively for both 24 h (P < 0.005) and 48 h LOS (P = 0.038). No significant difference in RR were observed (within 7 days) over the same periods. For admissions <48 h, the percentage of patients discharged increased for the Consultant-led teams (P < 0.006) before and after the new process. A statistically insignificant trend in relation to DDR was observed towards increased discharges over the weekend. DISCUSSION: The change in AMU process has resulted in improved DDR and patient length of stay, with no adverse effects on RR. SN - 1460-2393 UR - https://www.unboundmedicine.com/medline/citation/18417499/Improving_continuity_of_care_in_an_acute_medical_unit:_initial_outcomes_ L2 - https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/hcn042 DB - PRIME DP - Unbound Medicine ER -