What is the effect of a consultant presence in an acute medical unit?

McNeill, Gregor; Brahmbhatt, Darshan H.; Prevost, A. Toby; Trepte, Nicola

doi:10.7861/clinmedicine.9-3-214

Cited by 35 publications

(33 citation statements)

References 4 publications

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Section: Introductionmentioning

confidence: 99%

“…3,4 Notwithstanding the diagnosis, some conditions do not warrant in-patient management; indeed, up to a third of referrals seen in AMU are discharged on the same day. 5,6 This constitutes a significant proportion of patients that could potentially be assessed within the ambulatory emergency care setting.The RCP Acute Medicine Task Force 7 defines ambulatory emergency care (AEC) as 'the clinical care which may include diagnosis, observation, treatment and rehabilitation, not provided within the traditional hospital bed base or within the traditional outpatient services that can be provided across the primary-secondary care interface. In the context of acute medicine, it is the care of a condition that is perceived either by the patient or by the referring practitioner as urgent, and that requires prompt clinical assessment undertaken by a competent clinical decision maker.'…”

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confidence: 99%

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Selecting ambulatory emergency care (AEC) patients from the medical emergency in-take: the derivation and validation of the Amb score

et al. 2012

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-Accurate prediction of the likelihood of same-day discharge could make it possible to direct one-third of the medical in-take to an ambulatory care unit, thereby facilitating bed management. In Phase 1 of this study, we identified seven independent factors that contribute to an ambulatory care score (Amb score) that can potentially be used as a tool to select ambulatory emergency care (AEC) patients from the medical emergency in-take. A high score was associated with discharge within 12 hours of assessment and treatment in hospital. In Phase 2, we verified and internally validated the performance of the Amb score in a different cohort of patients, finding that it functioned well in identifying early discharges (ie AEC patients), with an area under the receiver operator curve (AUROC) of 0.91 (95% CI 0.88-0.94). An Amb score of у5 has a sensitivity of 96% (95% CI 90-98) and a specificity of 62% (95% CI 55-68) in identifying potential AEC patients.KEY WORDS: Amb score, ambulatory emergency care, admission, medical in-take BackgroundThe number of emergency hospital admissions and their costs continue to increase annually. 1 It is appropriate that all emergency referrals from primary care should be assessed in hospital, but admission is not always necessary. Acute medical units (AMU) help to reduce length of stay and prevent unnecessary admissions. 2 In addition, ambulatory care units contribute to admission-avoidance: many medical emergencies can be managed in the ambulatory care setting provided diagnostic services and assessment facilities are readily available. 3,4 Notwithstanding the diagnosis, some conditions do not warrant in-patient management; indeed, up to a third of referrals seen in AMU are discharged on the same day. 5,6 This constitutes a significant proportion of patients that could potentially be assessed within the ambulatory emergency care setting.The RCP Acute Medicine Task Force 7 defines ambulatory emergency care (AEC) as 'the clinical care which may include diagnosis, observation, treatment and rehabilitation, not provided within the traditional hospital bed base or within the traditional outpatient services that can be provided across the primary-secondary care interface. In the context of acute medicine, it is the care of a condition that is perceived either by the patient or by the referring practitioner as urgent, and that requires prompt clinical assessment undertaken by a competent clinical decision maker.' AEC patients tend to fall into one of four categories: a diagnostic exclusion group in which certain conditions, such as a possible deep venous thrombosis, must be ruled out; a low-risk group, such as those with communityacquired pneumonia with a low CURB65 score; a specific diagnostic group, who require a procedure such as pleural effusion; and finally, the group that requires a treatment that has traditionally been provided in an inpatient department, such as those with low-risk pulmonary embolism.In hospitals where AEC patients are managed in a geographically separate unit ...

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Selecting ambulatory emergency care (AEC) patients from the medical emergency in-take: the derivation and validation of the Amb score

et al. 2012

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“…This relates to the proven benefit of early decision making and intervention by senior, experienced members of the surgical team on morbidity and mortality in emergency surgical patients. 3,4 Elective work is therefore likely to suffer as a consequence.…”

Section: The Emergency Workloadmentioning

confidence: 99%

THE Future Delivery of Emergency Surgery in the UK

Surgeon¹,

Surgeon²

2013

Bulletin

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Over the past two decades, general surgeons have evolved and subspecialised. It is no longer plausible for a consultant to label him or herself as a true general surgeon in the traditional sense of the term. For example, a surgeon is very unlikely to have the training and experience to operate on all aspects of the gastrointestinal (GI) tract while still maintaining adequate skills in oncoplastic breast surgery and vascular surgery. To maintain adequate skill and up-to-date knowledge, it has become necessary for surgeons to focus on one area of general surgery, declaring an interest in that subspecialty while continuing to serve as a general surgeon for the purposes of the emergency on-call provision for general surgery.It has become necessary to centralise major and relatively infrequent specialist procedures in tertiary referral centres.

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“…There is increasing evidence to show that consultant presence and input in the emergency setting can decrease length of stay and potentially improve the quality of service delivery [1][2][3]. A National Confidential Enquiry into Patient Outcome and Death report identified a clinically significant delay in consultant review in 25% of acute inpatient deaths [4].…”

Section: Rationale For Changementioning

confidence: 99%