Acute medical units, more capacity without increasing resources

Schipper, Eleonora M.

doi:10.1016/j.ejim.2017.01.008

Cited by 2 publications

(2 citation statements)

References 2 publications

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“…With the increase in demand and considering the complexity of the morbidities presented by the patients, the EDs have been looking for strategies for the early identification of clinical deterioration, avoiding the occurrence of adverse events ( 5 ) . One of the main instruments used for this purpose is the risk classification system ( CR ), internationally known as screening ( 3 ) .…”

Section: Introductionmentioning

confidence: 99%

Association of the Charlson index with risk classification, clinical aspects, and emergency outcomes

Jesus

Okuno

Campanharo

et al. 2022

Rev. esc. enferm. USP

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Objective: To exam the association of the age-adjusted Charlson comorbidity index with the categories of risk classification, the clinical aspects, and the patient outcomes in the emergency department. Method: Cross-sectional, analytical study that analyzed the medical records of 3,624 patients seen in the emergency department. Charlson index scores greater than 2 showed a high rate of comorbidity (mortality risk). T-test and analysis of variance were applied in the analyses. Results: There was a significant difference between the Charlson comorbidity index and the risk classification, with higher scores found in patients classified in the white (2.57) and red (2.06) categories. Patients with vascular, endocrine, neurological, cardiologic, or device problems, and those who underwent a head tomography had a high rate of comorbidity. In addition, those admitted, transferred, or who died in the emergency room had significantly higher index scores compared to those who were discharged from the hospital. Conclusion: The high rate of comorbidity was associated with the categories of risk classification, main and nonspecific complaints, performance of a head tomography, and patient outcomes in the emergency room.

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Section: Introductionmentioning

confidence: 99%

Association of the Charlson index with risk classification, clinical aspects, and emergency outcomes

Jesus

Okuno

Campanharo

et al. 2022

Rev. esc. enferm. USP

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“…This model of acute care delivery has been adopted in the UK, Australia and New Zealand [15, 16], and more recently the Netherlands [17]. The majority of medical patients presenting to hospitals as emergencies in the UK are now assessed and treated in AMUs, either directly, or after triage in an Emergency Department [18], and these Units are considered essential for improving the quality of care for patients presenting to hospitals with complex medical conditions [19, 20].…”

Section: Introductionmentioning

confidence: 99%

A multistage mixed methods study protocol to evaluate the implementation and impact of a reconfiguration of acute medicine in Ireland’s hospitals

Hurley

McHugh

Browne

et al. 2019

BMC Health Serv Res

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BackgroundTo address deficits in the delivery of acute services in Ireland, the National Acute Medicine Programme (NAMP) was established in 2010 to optimise the management of acutely ill medical patients in the hospital setting, and to ensure their supported discharge to primary and community-based care. NAMP aims to reduce inappropriate hospital admissions, reduce length of hospital stay and ensure patients receive timely treatment in the most appropriate setting. It does so primarily via the development of Acute Medical Assessment Units (AMAUs) for the rapid assessment and management of medical patients presenting to hospitals, as well as streamlining the care of those admitted for further care. This study will examine the impact of this programme on patient care and identify the factors influencing its implementation and operation.MethodsWe will use a multistage mixed methods evaluation with an explanatory sequential design. Firstly, we will develop a logic model to describe the programme’s outcomes, its components and the mechanisms of change by which it expects to achieve these outcomes. Then we will assess implementation by measuring utilisation of the Units and comparing the organisational functions implemented to that recommended by the NAMP model of care. Using comparative case study research, we will identify the factors which have influenced the programme’s implementation and its operation using the Consolidated Framework for Implementation Research to guide data collection and analysis. This will be followed by an estimation of the impact of the programme on reducing overnight emergency admissions for potentially avoidable medical conditions, and reducing length of hospital stay of acute medical patients. Lastly, data from each stage will be integrated to examine how the programme’s outcomes can be explained by the level of implementation.DiscussionThis formative evaluation will enable us to examine whether the NAMP is improving patient care and importantly draw conclusions on how it is doing so. It will identify the factors that contribute to how well the programme is being implemented in the real-world. Lessons learnt will be instrumental in sustaining this programme as well as planning, implementing, and assessing other transformative programmes, especially in the acute care setting.

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Acute medical units, more capacity without increasing resources

Cited by 2 publications

References 2 publications

Association of the Charlson index with risk classification, clinical aspects, and emergency outcomes

Association of the Charlson index with risk classification, clinical aspects, and emergency outcomes

A multistage mixed methods study protocol to evaluate the implementation and impact of a reconfiguration of acute medicine in Ireland’s hospitals

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