-A cornerstone of the development of acute medicine has been the principle of consultant presence within the acute medical unit (AMU). There is the hypothesis that consultant supervision improves patient care. This view is not currently supported by firm scientific evidence. When Ipswich AMU opened in 2004, there was a consultant presence on some weekdays only. Admission data were collected and assessed with respect to the presence or absence of the consultant. Overall length of stay was significantly lower, by a mean of 1.3 days, when there was a consultant present, and 9% more patients were discharged on the same day of their assessment (95% confidence interval 5.7% to 12.6%, pϽ0.001) without affecting readmission or mortality. These results suggest the absence of a consultant leads to fewer same-day discharges and causes the inappropriate admission of patients not needing inpatient management. Further study is required to determine whether these findings are shared by other AMUs.
Our survey suggests that despite some variation in staffing and procedures, MAU seem to be well established and a promising means of decreasing ED access block. Future comparative study is required to evaluate further the effect of MAU on ED access block and ED length of stay.
-The Surviving Sepsis Campaign (SSC) advocates a six-hour resuscitation care bundle to be used in the initial management of the acutely ill patient. This survey was designed to investigate the number of acute medicine units (AMUs) in the UK capable of, and successful in, implementing this bundle. Questionnaires were sent to each of the 265 AMUs across the UK. The questionnaire asked 10 questions about delivery of the six-hour resuscitation bundle. Twenty AMUs (12%) had the minimum facilities to comply. Regional variation was noted. This survey shows that few AMUs in the UK appear to be able to resuscitate a patient with sepsis using the SSC resuscitation care bundle.
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