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Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.
PLoS One. 2013; 8(4):e61476.Plos

Abstract

Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An 'all inclusive' pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

Authors+Show Affiliations

Imperial College, London, United Kingdom. d.bell@imperial.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23613858

Citation

Bell, Derek, et al. "Consultant Input in Acute Medical Admissions and Patient Outcomes in Hospitals in England: a Multivariate Analysis." PloS One, vol. 8, no. 4, 2013, pp. e61476.
Bell D, Lambourne A, Percival F, et al. Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis. PLoS One. 2013;8(4):e61476.
Bell, D., Lambourne, A., Percival, F., Laverty, A. A., & Ward, D. K. (2013). Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis. PloS One, 8(4), e61476. https://doi.org/10.1371/journal.pone.0061476
Bell D, et al. Consultant Input in Acute Medical Admissions and Patient Outcomes in Hospitals in England: a Multivariate Analysis. PLoS One. 2013;8(4):e61476. PubMed PMID: 23613858.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis. AU - Bell,Derek, AU - Lambourne,Adrian, AU - Percival,Frances, AU - Laverty,Anthony A, AU - Ward,David K, Y1 - 2013/04/17/ PY - 2012/10/16/received PY - 2013/03/10/accepted PY - 2013/4/25/entrez PY - 2013/4/25/pubmed PY - 2013/11/12/medline SP - e61476 EP - e61476 JF - PloS one JO - PLoS One VL - 8 IS - 4 N2 - Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An 'all inclusive' pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/23613858/Consultant_input_in_acute_medical_admissions_and_patient_outcomes_in_hospitals_in_England:_a_multivariate_analysis_ L2 - https://dx.plos.org/10.1371/journal.pone.0061476 DB - PRIME DP - Unbound Medicine ER -