2012

Project Steering GroupChaired by Professor Derek Bell

An evaluation of consultant input into acute medical admissions management Hospital service patterns v clinicaloutcomes in England

Hypothesis:

Better patient outcomes areassociated with more continuousconsultant care.

Objectives:• Describe current staffing for

management of adult acute medical admission

• Audit against national guidelines• Explore correlations between service

pattern and patient outcomes• Recommend optimum service model

and consultant staffing • Highlight areas of concern for further

study.

Approach:

• Web based survey of acute medical admissions to hospitals between February and April 2010

• Survey responses analysed for correlation with patient outcomes derived from HES (England).

Results:against national recommendations• Patterns of work still reflect

‘consultant’ of the day rather than consultant of several days

• In almost half of the hospitals the first consultant on call undertakes other routine clinical duties rather than being dedicated to acute take

• In many hospitals acute medical patients are consultant reviewed once a day not twice daily.

Results:correlation analysis between outcomes and hypothesis derived variables.Hospitals in which:• admitting consultants have no fixed other

clinical commitments whilst on take had a lower adjusted case fatality rate

• admitting consultants work blocks of more than 1 day had a lower excess weekend mortality

• there were 2 or more AMU ward rounds per day(all patients reviewed) had a lower adjusted case fatality rate for patients with a hospital length stay of more than 7 days.

Recommendations:Hospitals which have not yet adopted best practice for consultant rotas and job plans should urgently assure that admitting consultants:• be in the AMU for more than 4 hours 7 days

per week• have no other fixed clinical commitments• perform twice daily consultant reviews of all

AMU patients• undertake acute cover in blocks of days.Acute Medicine task force

Recommendations:

Physician consultant presence on site for 12 hours per day seven days per week.(RCP position statement)

Recommendations

Research and quality improvement work should be undertaken to further develop understanding of all factors affecting higher weekend patient mortality.

This should include further analysis of existing data to explore relative importance of organisational structures and workforce.

http://www.rcplondon.ac.uk/resources/acute-medicine-evaluation