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An evaluation of consultant input into acute medical admissions management

An evaluation of consultant input into acute medical admissions management. Hospital service patterns v clinical outcomes in England. Hypothesis:. Better patient outcomes are associated with more continuous consultant care. Objectives:.

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An evaluation of consultant input into acute medical admissions management

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  1. An evaluation of consultant input into acute medical admissions management Hospital service patterns v clinical outcomes in England Project Steering Group Chaired by Professor Derek Bell

  2. Hypothesis: • Better patient outcomes are • associated with more continuous • consultant care.

  3. 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.

  4. 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).

  5. 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.

  6. 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.

  7. 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

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

  9. 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.

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

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