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QJM Advance Access originally published online on April 15, 2008
QJM 2008 101(7):529-533; doi:10.1093/qjmed/hcn042
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© The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Improving continuity of care in an acute medical unit: initial outcomes

Victoria J. St Noble1, Gary Davies1 and Derek Bell2

From the 1Department of Medicine, Chelsea and Westminster Hospital and 2Imperial College London, Chelsea and Westminster Hospital

Address correspondence to Professor D. Bell (Medicine), 4th floor, Main Building, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW3 2EH.

Received 6 November 2007 and in revised form 28 February 2008


  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.


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