Résumé

Background: Benchmarking is important to improve quality of care. Aim: To audit the performance of Acute Medical Units (AMUs) against the clinical quality indicators published by the Society for Acute Medicine (SAM). Methods: 24-hour data collection on the 20th of June 2013 with follow-up data at 72 hours. Results: 43 units submitted data on 1425 patients. 76% of patients had early warning scores recorded within 30 minutes of admission, 95% of patients had been seen by a competent decision maker within four hours. 79% of patients were seen by a consultant physicians within the appropriate period of time. Conclusion: The difference in compliance with quality standards between UK units opens opportunities for learning. The reasons why some units perform better than others require further investigation.

Background: The absence of published data for benchmarking serves as a disincentive for Acute Medical Units to improve care. Aim: To test feasibility of a national audit in Acute Medicine for compliance with common standards Methods: On line questionnaire with summary data for patients admitted to participating Acute Medicine Units over a 24-hour-period. Results: 30 units submitted summary data. The mean number of admission was 36 (SD 14). Compliance with standards around timing of junior and senior review was highly variable. In almost all other standards only a small number of units achieved high reliability with compliance of more than 90%. Conclusion: SAMBA provides a data set that can be used for local and national benchmarking and quality improvement work. Annual audit might be beneficial to track improvements.

Background: The Society for Acute Medicine’s Benchmarking Audit (SAMBA) serves as a tool for Acute Medical Units to compare and improve their quality of care. Aim: To audit the performance of Acute Medical Units against clinical quality indicators, standards by the Royal College of Physicians and Specialist Societies relevant to the practice of Acute Medicine. Methods: An online survey of unit profiles and staffing levels on the audit day was followed by a 24-hour data collection on Thursday the 19th of June 2014 for all patients seen by the local Acute Medicine teams as part of the general medical take. Patients were followed-up for 72 hours. We reviewed the impact of staffing levels on performance indicators. Results: 66 Acute Medical Units admitted 2333 patients during the 24-hour period. Compliance with the quality standards of SAM was as follows: 84% of patients had an early warning score recorded within 30 minutes of admission, 81% of patients had been seen by a competent decision maker within four hours and 73% of patients were seen by a consultant physician within the appropriate period of time. Only 56% of patients received a standard of care compatible with all three quality standards. We found no relation between unit characteristics, staffing and performance indicator. Conclusion: There remains a gap between the standard described by the quality indicators and the performance of Acute Medical Units during a one-day audit.

The Society for Acute Medicine’s Benchmarking Audit (SAMBA) was undertaken for the 5th time in June 2016. For the first time, data on telephone triage calls prior to admission to Acute Medical Units were collected: 1238 patients were referred from Emergency Departments, 925 from General Practitioners (GPs), 52 from clinics and 147 from other sources. Calls from Emergency Departments rarely resulted in admission avoidance. Calls from Primary Care resulted in avoidance of an admission in 115 (12%) patients; the percentage of avoided admissions was highest if the call was taken by a Consultant. Consultant triage might result in admission avoidance but the impact of local context on the effectiveness is not clear.