The performance of acute medical units (AMUs) against published quality indicators is variable. We aimed to identify the impact of case-mix and unit resources on timely assessment and discharge of patients admitted to 43 AMUs on a single day in June 2013, as part of the Society for Acute Medicine's benchmarking audit 2013. Performance against quality indicators was at its worst in the early evening hours. Units admitting fewer than 40 patients performed better. Patients who were more frail, as measured by the Clinical Frailty Scale, were also more likely to have signifi cant physiological abnormalities and a higher risk of death, as measured by the National Early Warning Score. Our analysis suggests that resource allocation at the front door is related to quality indicators. Teams will need strengthening in the evening hours and if looking after higher numbers of frail patients.

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.

Specialist in acute care might facilitate discharge in a higher proportion of patients.

Acute Internal Medicine (AIM) may be the ‘new kid on the block’ as a medical specialty but it lies at the heart of our health service. Recognition of the importance of early senior review in managing medical patients admitted to hospital in an emergency has led to a dramatic expansion in the number of consultant posts being created in acute medical units across the UK. This has been matched by a similar rise in the number of higher speciality training positions, with over 100 posts being advertised every year. Although the majority of these posts have been filled, this expansion, combined with a relative lack of awareness of the speciality, has meant that vacancies remain in many Deaneries. This needs to be addressed in order for the speciality to continue to expand, and deliver high quality, consultant-led acute medical care in every hospital in the UK.

To improve the efficiency of the inpatient referral process to medical specialties. Inpatient referrals to medical specialties at Kingston Hospital are done in many different ways with no unified system. Specialties use paper forms, magnets on whiteboards, phone referrals, Excel spreadsheets or even the fax machine. The highest volume of inpatient referrals to all medical specialties is from the acute assessment unit (AAU). By creating a standardised electronic referral system to medical specialties, a referral can be made from, and reviewed by, the specialty team from any computer in the hospital. A triage system will be trialled to enable specialty teams to prioritise the order of referrals by urgent, routine or telephone advice only. We hope to improve efficiency when referring patients, become paper-free and reduce the number of bleeps and re-referrals made when the status of a referral is unknown. This system will also allow referrals to be more visible and improve the ability to audit them.