Reforming the acute phase of the inpatient journey.

The medical admissions unit (MAU) of the Royal Free Hospital, London, should receive all acute accident and emergency (A&E) medical admissions. The unit aims to discharge 60% of patients and to transfer the remainder to a base ward within 48 hours of admission. This study tracked the patient journey from admission to A&E through the MAU during two parallel weeks, one year apart. Key bottlenecks were identified in the first audit and reforms implemented prior to the second. These reforms included improved transfer to base wards, improved weekend work patterns and improved access to investigation, specialist teams and pharmacy. The reforms served to facilitate the patient journey. A greater proportion of acute medical admissions were managed on the MAU and the number of patients exceeding a 48-hour stay fell from 55% to 10%. Both study periods demonstrated a peak in transfer activity from A&E in the 20 minutes before the four-hour target.