Effectiveness of acute medical units in hospitals: a systematic review

Scott, Ian A; Vaughan, Louella; Bell, Derek

doi:10.1093/intqhc/mzp045

Cited by 173 publications

(190 citation statements)

References 16 publications

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“…A review of nine before-and-after studies of AMUs, reports significant reductions in inpatient mortality, decreased length of stay and improved hospital functioning [26].…”

Section: Introductionmentioning

confidence: 99%

Overcrowding in emergency department: an international issue

Somma

Paladino

Vaughan³

et al. 2014

Intern Emerg Med

310

219

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Overcrowding in the emergency department (ED) has become an increasingly significant worldwide public health problem in the last decade. It is a consequence of simultaneous increasing demand for health care and a deficit in available hospital beds and ED beds, as for example it occurs in mass casualty incidents, but also in other conditions causing a shortage of hospital beds. In Italy in the last 12-15 years, there has been a huge increase in the activity of the ED, and several possible interventions, with specific organizational procedures, have been proposed. In 2004 in the United Kingdom, the rule that 98 % of ED patients should be seen and then admitted or discharged within 4 h of presentation to the ED ('4 h rule') was introduced, and it has been shown to be very effective in decreasing ED crowding, and has led to the development of further acute care clinical indicators. This manuscript represents a synopsis of the lectures on overcrowding problems in the ED of the Third Italian GREAT Network Congress, held in Rome, 15-19 October 2012, and hopefully, they may provide valuable contributions in the understanding of ED crowding solutions.

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“…A review of nine before-and-after studies of AMUs, reports significant reductions in inpatient mortality, decreased length of stay and improved hospital functioning [26].…”

Section: Introductionmentioning

confidence: 99%

Overcrowding in emergency department: an international issue

Somma

Paladino

Vaughan³

et al. 2014

Intern Emerg Med

310

219

View full text Add to dashboard Cite

show abstract

“…Furthermore, these patients may benefit from early intervention and expedited admission processes, such as those offered by medical admission units. 32 People arriving by ambulance spending more than 4 h in the ED were admitted in higher proportions (60% vs 40%) and had odds of admission sixfold higher than those spending <4 h in the ED. This finding may be explained by an inadvertent pressure on medical staff to admit, rather than discharge.…”

Section: Prevalence and Predictors Of Hospital Admissionmentioning

confidence: 93%

Expanding emergency department capacity: a multisite study

Crilly

Keijzers

Tippett

et al. 2014

Aust. Health Review

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Objectives. The aims of the present study were to identify predictors of admission and describe outcomes for patients who arrived via ambulance to three Australian public emergency departments (EDs), before and after the opening of 41 additional ED beds within the area.Methods. The present study was a retrospective comparative cohort study using deterministically linked health data collected between 3 September 2006 and 2 September 2008. Data included ambulance offload delay, time to see doctor, ED length of stay (LOS), admission requirement, access block, hospital LOS and in-hospital mortality. Logistic regression analysis was undertaken to identify predictors of hospital admission.Results. Almost one-third of all 286 037 ED presentations were via ambulance (n = 79 196) and 40.3% required admission. After increasing emergency capacity, the only outcome measure to improve was in-hospital mortality. Ambulance offload delay, time to see doctor, ED LOS, admission requirement, access block and hospital LOS did not improve. Strong predictors of admission before and after increased capacity included age >65 years, Australian Triage Scale (ATS) Category 1-3, diagnoses of circulatory or respiratory conditions and ED LOS >4 h. With additional capacity, the odds ratios for these predictors increased for age >65 years and ED LOS >4 h, and decreased for ATS category and ED diagnoses.Conclusions. Expanding ED capacity from 81 to 122 beds within a health service area impacted favourably on mortality outcomes, but not on time-related service outcomes such as ambulance offload time, time to see doctor and ED LOS. To improve all service outcomes, when altering (increasing or decreasing) ED bed numbers, the whole healthcare system needs to be considered. MODELS OF CAREWhat is known about the topic? Escalating growth in demand for emergency patient services has placed increasing strain on both ambulance and hospital resources. Poor patient outcomes can result from crowded EDs and hospitals. What does this paper add? This paper identifies that following the opening of a 41-bed ED within a health service area, there was an improvement in in-hospital mortality outcomes for those who arrived to the ED via ambulance. Data linkage enhanced our ability to report on and understand the impact on outcomes across several systems (ambulance, ED and hospital admission). This paper provides a foundation for further research regarding emergency services expansion from a geographical area-wide perspective. Easily identifiable predictors of hospital admission for ambulance-arriving patients that may be useful for informing patient flow strategies are highlighted. What are the implications for practitioners? Practitioners need to be aware that patients arriving by ambulance to the ED are more likely to require admission if they are older, triaged to higher acuity, have circulatory or respiratory conditions and have an ED LOS of >4 h. Service planners need to consider the whole system when planning expansion.

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“…Participants perceived that the Acute Medical Unit (AMU) and Care of the Older Person's ward were the optimal settings for frailty assessment, and that the frailty assessment tool should be clinically relevant, simple (easy to use) and accessible or useful to the multidisciplinary team. This may reflect the fact that the majority of emergency medical admissions occur through AMUs in the UK setting (232). There appeared to be clear bipolarity of agreement regarding the number of frailty indicators that could be reliably measured in the acute medical care setting, with the majority centred around 5 items (mode) and a smaller proportion for >10 items.…”

Section: Optimal Frailty Indicators In the Acute Care Settingmentioning

confidence: 99%

Frailty Assessment in Acute Care

2015

The Gerontologist

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IntroductionFor some people, ageing is associated with the experience of increased co-morbidity, functional impairment, poor resilience and heightened vulnerability to external stressors, resulting in reduced lifespan as well as health-span. This frailty phenomenon poses challenges to health care systems in the form of increased patient complexity and resource utilisation. The acute care setting, characterised by time-pressure and high patient turn-over, is under strain and struggles to recognise and subsequently reliably intervene, to prevent, reverse or halt the decline of this vulnerable cohort. MethodsThis mixed-methods study probes existing evidence and 'real-world' processes with a systematic review of frailty assessments developed or validated in the acute care setting and a survey of contemporaneous clinical practice in London Acute Medical Units. Content validation and understanding of contextual factors for ideal frailty assessment in acute care is explored using Delphi consensus and Focus Group methodology respectively. The resultant model is developed on existing retrospective national Hospital Episode Statistics data, and prospectively tested on observational data in a local Acute Medical Unit setting. ResultsExisting frailty scores are preponderantly biophysical in nature, and have poor predictive power for adverse outcomes in the acute care setting. In clinical practice, single-dimension assessment tools predominate. Frailty syndromes and previous high resource utilisation in the form of a simple, clinically relevant tool useful to the multidisciplinary team gain consensus as optimal assessment for the setting. Retrospective testing of the frailty model displays moderate predictive powers for adverse events (inpatient mortality, emergency readmission and institutionalisation) and prospective testing provides concurrent (Frailty Index, Age, Co-Morbidity) and comparative predictive validity (Frailty Index, Co-Morbidity, 2 admission National Early Warning Score) with existing risk stratification models in this setting. ConclusionsA risk prediction model based on frailty syndromes and previous high resource utilisation is a valid, feasible and useful for the acute care setting.

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Effectiveness of acute medical units in hospitals: a systematic review

Abstract: Limited observational data suggest AMUs reduce in-patient mortality, length of stay and emergency department access block without increasing readmission rates, and improve patient and staff satisfaction.

Cited by 173 publications

References 16 publications

Overcrowding in emergency department: an international issue

Overcrowding in emergency department: an international issue

Expanding emergency department capacity: a multisite study

Frailty Assessment in Acute Care

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