Abstract
Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An ‘all inclusive’ pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.
Highlights
Acute medicine in the UK, Europe and Australia has developed over the last 15 years in response to the increasing number of medical admissions, concerns over the quality of acute care and other external pressures, including the European Working Time Directive
This study explores the potential relationship between the recommended Consultant patterns of work and clinical outcomes for patients admitted as a medical emergency
This meant that in these cases the outcome measures were only available for the overall trust, which may encompass more than one acute hospital
Summary
Acute medicine in the UK, Europe and Australia has developed over the last 15 years in response to the increasing number of medical admissions, concerns over the quality of acute care and other external pressures, including the European Working Time Directive. Published data [4] including the National Confidential Enquiry into Patient Outcome and Death reports [5,6] suggest that delays in review of patients and in obtaining senior opinion can contribute to avoidable deaths. This would suggest that medical patterns of work should be designed to improve outcomes. This study explores the potential relationship between the recommended Consultant patterns of work and clinical outcomes for patients admitted as a medical emergency
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
