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.
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: Saul Blecker; Keith Goldfeld; Hannah Park; Martha J Radford; Sarah Munson; Fritz Francois; Jonathan S Austrian; R Scott Braithwaite; Katherine Hochman; Richard Donoghue; Bernard A Birnbaum; Marc N Gourevitch Journal: J Gen Intern Med Date: 2015-05-07 Impact factor: 5.128
Authors: John Ty Soong; Audrey LA Wong; Imogen O'Connor; Milka Marinova; Dale Fisher; Derek Bell Journal: Clin Med (Lond) Date: 2021-08-10 Impact factor: 5.410
Authors: Lukasz Tanajewski; Matthew Franklin; Georgios Gkountouras; Vladislav Berdunov; Judi Edmans; Simon Conroy; Lucy E Bradshaw; John R F Gladman; Rachel A Elliott Journal: PLoS One Date: 2015-05-05 Impact factor: 3.240
Authors: Jung Hun Ohn; Nak Hyun Kim; Eun Sun Kim; Seon Ha Baek; Yejee Lim; Jaehyung Hur; Yun Jong Lee; Eu Suk Kim; Hak Chul Jang Journal: J Korean Med Sci Date: 2017-12 Impact factor: 2.153