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Canetta C, Accordino S, La Boria E, Arosio G, Cacco S, Formagnana P, Masotti M, Provini S, Passera S, Viganò G, Sozzi F. Effects of a medical admission unit on in-hospital patient flow and clinical outcomes. Eur J Intern Med 2024:S0953-6205(24)00188-2. [PMID: 38735801 DOI: 10.1016/j.ejim.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/28/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND the burden of acute complex patients, increasingly older and poli-pathological, accessing to Emergency Departments (ED) leads up hospital overcrowding and the outlying phenomenon. These issues highlight the need for new adequate patients' management strategies. The aim of this study is to analyse the effects on in-hospital patient flow and clinical outcomes of a high-technology and time-limited Medical Admission Unit (MAU) run by internists. METHODS all consecutive patients admitted to MAU from Dec-2017 to Nov-2019 were included in the study. The admissions number from ED and hospitalization rate, the overall in-hospital mortality rate in medical department, the total days of hospitalization and the overall outliers bed days were compared to those from the previous two years. RESULTS 2162 patients were admitted in MAU, 2085(95.6%) from ED, 476(22.0%) were directly discharged, 88(4.1%) died and 1598(73.9%) were transferred to other wards, with a median in-MAU time of stay of 64.5 [0.2-344.2] hours. Comparing the 24 months before, despite the increase in admissions/year from ED in medical department (3842 ± 106 in Dec2015-Nov2017 vs 4062 ± 100 in Dec2017-Nov2019, p<0.001), the number of the outlier bed days has been reduced, especially in surgical department (11.46 ± 6.25% in Dec2015-Nov2017 vs 6.39 ± 3.08% in Dec2017-Nov2019, p=0.001), and mortality in medical area has dropped from 8.74 ± 0.37% to 7.29 ± 0.57%, p<0.001. CONCLUSIONS over two years, a patient-centred and problem-oriented approach in a medical admission buffer unit run by internists has ensured a constant flow of acute patients with positive effects on clinical risk and quality of care reducing medical outliers and in-hospital mortality.
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Affiliation(s)
- Ciro Canetta
- High Care Internal Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Italy
| | - Silvia Accordino
- High Care Internal Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Italy.
| | - Elisa La Boria
- Internal Medicine and Medical Admission Unit, Ospedale Maggiore of Crema, ASST Crema, Italy
| | - Gianpiero Arosio
- Internal Medicine and Medical Admission Unit, Ospedale Maggiore of Crema, ASST Crema, Italy
| | - Silvia Cacco
- Post Acute Medicine Unit, Foundation IRCCS Istituti Clinici Scientifici Salvatore Maugeri of Milan, Italy
| | - Pietro Formagnana
- Internal Medicine and Medical Admission Unit, Ospedale Maggiore of Crema, ASST Crema, Italy
| | - Michela Masotti
- Internal Medicine and Medical Admission Unit, Ospedale Maggiore of Crema, ASST Crema, Italy
| | - Stella Provini
- Internal Medicine Unit, Ospedale Civico of Codogno, ASST Lodi, Italy
| | - Sonia Passera
- Internal Medicine and Medical Admission Unit, Ospedale Maggiore of Crema, ASST Crema, Italy
| | - Giovanni Viganò
- Internal Medicine and Medical Admission Unit, Ospedale Maggiore of Crema, ASST Crema, Italy
| | - Fabiola Sozzi
- Cardiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Italy
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Ibrahim H, Mohamad MK, Adi AAK, Kamour AM, Harhara T. The Impact of an Acute Medical Unit in Internal Medicine on Resident Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221091037. [PMID: 35399787 PMCID: PMC8984854 DOI: 10.1177/23821205221091037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical trainees are expected to provide care for increasingly sick and treatment intensive patients. To improve patient care, hospitals worldwide have developed acute medical units (AMUs), dedicated medical wards that provide care for patients during the first 24 to 72 hours of an emergency medical hospital admission. A distinguishing feature of these units is that they are supervised by senior clinicians and offer multidisciplinary patient-centered care. Little is known about the impact of AMUs on trainee supervision and education. METHODS In this educational case study, we describe the evolution, process and structure of our AMU service. We also provide resident and teaching faculty perceptions of the impact of this intervention on education and supervision. RESULTS Questionnaire results showed that residents and teaching attendings believed that supervision and education were improved on the AMU, as compared to the traditional medical ward model. Residents also felt that their knowledge and clinical skills in managing acute patients improved. Procedure skills were less impacted by the intervention. A small number of residents believed that the AMU model worsened supervision and education. CONCLUSION Integrating medical trainees into an AMU allowed for early evaluation and input from senior clinicians and increased opportunities to work in and learn from multidisciplinary teams, contributing to improved resident supervision and education. Future studies are needed to assess the long-term impact of the AMU on educational outcomes.
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Affiliation(s)
- Halah Ibrahim
- Khalifa University College of Medicine and Health Sciences, Abu
Dhabi, United Arab Emirates
| | - Mohamad Kasem Mohamad
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi,
United Arab Emirates
| | - Abd Al Kareem Adi
- Education Institute, Sheikh Khalifa Medical City, Abu Dhabi, United
Arab Emirates
| | - Ashraf M. Kamour
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi,
United Arab Emirates
| | - Thana Harhara
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi,
United Arab Emirates
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Khan U, Menezes CN, Govind N. Patterns and outcomes of admissions to the medical acute care unit of a tertiary teaching hospital in South Africa. Afr J Emerg Med 2021; 11:26-30. [PMID: 33318914 PMCID: PMC7725673 DOI: 10.1016/j.afjem.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A Medical Acute Care Unit (MACU) was established at Chris Hani Baragwanath Academic Hospital (CHBAH) to provide comprehensive medical specialist care to the patients presenting with acute medical emergencies. Improved healthcare delivery systems at the MACU may result in shorter hospital stays, better outcomes, and less mortality. OBJECTIVES The study's objective was to describe the demographics, diagnoses, disease patterns, and outcomes, including patient's mortality, admitted to the MACU at CHBAH. METHODS Records of 200 patients admitted, between March 2015 to August 2015, to the MACU at CHBAH were reviewed. Patient demographics, diagnosis at admission, duration of stay, and outcomes were documented. Patients transferred to the medical ward, the Intensive Care Unit (ICU), or discharge. The leading causes of mortality were documented. RESULTS Of the 200 patients, 59% were females. The patients' mean age was 46 (17.2) years, and the mean duration of stay at the MACU was 1.45 (1.25) days. Non-communicable diseases accounted for 76% of admissions. The most frequently diagnosed conditions included: diabetic ketoacidosis acidosis (DKA) and hyperosmolar non-ketotic (HONK) (17.5%), non-accidental self-poisoning (16%), hypertensive emergencies (9.5%), decompensated cardiac failure (8%) and ischemic heart disease (7%). Infectious diseases comprised 14% of the diagnoses, of which cases of pneumonia were the most common (5%). Most patients (77.5%) were transferred to medical wards, 12% to ICU, while 10% demised at the MACU. The leading causes of death included sepsis (25%), DKA/HONK (20%), non-accidental self-poisoning (10%), and cardiac failure (10%). CONCLUSION Non-communicable diseases, particularly diabetic emergencies, were the leading causes of admission to the MACU at CHBAH. During the study period, high rates of case improvement, patient discharge, shorter hospital stay, and less mortality were observed. The leading cause of mortality was sepsis related.
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Vaughan L, Bardsley M, Bell D, Davies M, Goddard A, Imison C, Melnychuk M, Morris S, Rafferty AM. Models of generalist and specialist care in smaller hospitals in England: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The increasing number of older, complex patients who require emergency admission to hospital has prompted calls for better models of medical generalist care, especially for smaller hospitals, whose size constrains resources and staffing.
Objective
To investigate the strengths and weaknesses of the current models of medical generalism used in smaller hospitals from patient, professional and service perspectives.
Methods
The design was a mixed-methods study. Phase 1 was a scoping and mapping exercise to create a typology of models of care, which was then explored further through 11 case studies. Phase 2 created a classification using the Hospital Episode Statistics of acute medical ‘generalist’ and ‘specialist’ work and described differences in workload and explored the links between case mix, typology and length of stay and between case mix and skill mix. Phase 3 analysed the relationships between models of care and patient-level costs. Phase 4 examined the strengths and weaknesses of the models of care through focus groups, a discrete choice experiment and an exploration of the impact of typology on other outcomes.
Results
In total, 50 models of care were explored through 48 interviews. A typology was constructed around generalist versus specialist patterns of consultant working. Twenty-five models were deployed by 48 hospitals, and no more than four hospitals used any one model of care. From the patient perspective, analysis of Hospital Episode Statistics data of 1.9 million care episodes found that the differences in case mix between hospitals were relatively small, with 65–70% of episodes accounted for by 20 case types. The skill mix of hospital staff varied widely; there were no relationships with case mix. Patients exhibited a preference for specialist care in the discrete choice experiment but indicated in focus groups that overall hospital quality was more important. From a service perspective, qualitative work found that models of care were contingent on complex constellations of factors, including staffing, the local hospital environment and policy imperatives. Neither the model of care nor the case mix accounted for variability in the length of stay (no associations were significant at p < 0.05). No significant differences were found in the costs of the models. Professionally, the preferences of doctors for specialist versus generalist work depended on their experiences of providing care and were associated with a healthy organisational culture and a co-operative approach to managing emergency work. Concepts of medical generalism were found to be complex and difficult to define, with theoretical models differing markedly from models in action.
Limitations
Smaller hospitals in multisite trusts were excluded, potentially leading to sample bias. The rapidly changing nature of the models limited the analysis of typology against outcomes.
Conclusions
The case mix of smaller hospitals was dominated by patients with presentations amenable to generalist approaches to care; however, there was no evidence to support any particular pattern of consultant working. Matching hospital staff to better meet local need and the creation of more collaborative working environments appear more likely to improve care in smaller hospitals than changing models.
Future work
The exploration of the relationships between workforce, measures of hospital culture, models of care, costs and outcomes in both smaller and larger hospitals is urgently required to underpin service reforms.
Study registration
This study is registered as Integrated Research Application System project ID 191393.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
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Sullivan P, Saatchi G, Younis I, Harris ML. Diffusion of knowledge and behaviours among trainee doctors in an acute medical unit and implications for quality improvement work: a mixed methods social network analysis. BMJ Open 2019; 9:e027039. [PMID: 31826886 PMCID: PMC6924864 DOI: 10.1136/bmjopen-2018-027039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe the social networks that diffuse knowledge, attitudes and behaviours relating to different domains of practice within teams of trainee doctors in an acute hospital medical setting. The domains examined were 'clinical-technical', 'patient centredness' and 'organisation of work'. DESIGN Sequential mixed methods: (i) sociocentric survey of trainee consisting of questions about which colleagues are emulated or looked to for advice, with construction of social network maps, followed by (ii) semi-structured interviews regarding peer-to-peer influence, analysed using a grounded theory approach. The study took place over 24 months. SETTING An acute medical admissions unit, which receives admissions from the emergency department and primary care, in a National Health Service England teaching hospital. PARTICIPANTS Trainee medical doctors working in five consecutive rotational teams. Surveys were done by 39 trainee doctors; then 15 different participants from a maximal diversity sample were interviewed. RESULTS Clinical-technical behaviours spread in a dense network with rich horizontal peer-to-peer connections. Patient-centred behaviours spread in a sparse network. Approaches to non-patient facing work are seldom copied from colleagues. Highly influential individuals for clinical technical memes were identified; high influencers were not identified for the other domains. CONCLUSION Information and influence relating to different aspects of practice have different patterns of spread within teams of trainee doctors; highly influential individuals were important only for spread of clinical-technical practice. Influencers have particular characteristics, and this knowledge could guide leaders and teachers.
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Ohn JH, Kim NH, Kim ES, Baek SH, Lim Y, Hur J, Lee YJ, Kim ES, Jang HC. An Acute Medical Unit in a Korean Tertiary Care Hospital Reduces the Length of Stay and Waiting Time in the Emergency Department. J Korean Med Sci 2017; 32:1917-1920. [PMID: 29115071 PMCID: PMC5680488 DOI: 10.3346/jkms.2017.32.12.1917] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/05/2017] [Indexed: 11/20/2022] Open
Abstract
A hospitalist-run acute medical unit (AMU) opened at a tertiary care hospital on August 2015 for the first time in Korea. Patients visiting the emergency department (ED) with acute medical problems are admitted to the AMU. They stay in that unit for less than 72 hours and are discharged or transferred to specialty wards if longer treatment is necessary. We reviewed 19,450 medical admissions through the ED from January 2014 to September 2016. The median length of stay (LOS) significantly decreased from 10.0 days (interquartile range [IQR], 5.5-16.7) to 9.1 days (IQR, 5.1-15.0) (P < 0.001) after the establishment of the AMU. The median waiting time in the ED significantly shortened by 40% (P < 0.001). Future studies on the impact of AMU on in-patient morbidity, mortality, re-admission rate, and patient or staff satisfaction are necessary.
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Affiliation(s)
- Jung Hun Ohn
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nak Hyun Kim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Sun Kim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seon Ha Baek
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yejee Lim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jaehyung Hur
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak Chul Jang
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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7
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Handover Structure and Quality in the Acute Medical Assessment Unit: A Prospective Observational Study. J Patient Saf 2017; 15:224-229. [DOI: 10.1097/pts.0000000000000221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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van Galen LS, Lammers EMJ, Schoonmade LJ, Alam N, Kramer MHH, Nanayakkara PWB. Acute medical units: The way to go? A literature review. Eur J Intern Med 2017; 39:24-31. [PMID: 27843036 DOI: 10.1016/j.ejim.2016.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute healthcare chains in the Netherlands are increasingly under pressure because of rising emergency department (ED) admissions, relative bed shortages and government policy changes. In order to improve acute patient flow and quality of care through hospitals, an acute medical unit (AMU) might be a solution, as demonstrated in the UK. However, limited information is available concerning AMUs in the Netherlands. Therefore, the aims of this study were to METHODS: A systematic literature search was performed searching 3 electronic databases: PubMed, Cochrane and EMBASE. All 106 hospitals in the Netherlands were contacted, inquiring about the status of an ED, the AMU or future plans to start one. RESULTS The literature search resulted in 31 studies that met inclusion criteria. In general, these studies reported significant benefits on number of admissions, hospital length of stay (LOS), mortality, other wards and readmissions. Among the Dutch hospitals with an ED, 33 out of 93 implemented an AMU or similar ward, these are however organized heterogeneously. Following current trends, more AMUs are expected to be realized in the future. CONCLUSION In order to improve the current strain on the Dutch acute healthcare system, an AMU could potentially provide benefits. However, uniform guideline is warranted to optimize and compare quality of care throughout the Netherlands.
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Affiliation(s)
- L S van Galen
- VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
| | - E M J Lammers
- VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
| | - L J Schoonmade
- VU University Medical Centre, Medical Library, VU University, Amsterdam, The Netherlands
| | - N Alam
- VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
| | - M H H Kramer
- VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
| | - P W B Nanayakkara
- VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands.
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Sullivan P, Bell D. Investigation of the degree of organisational influence on patient experience scores in acute medical admission units in all acute hospitals in England using multilevel hierarchical regression modelling. BMJ Open 2017; 7:e012133. [PMID: 28100561 PMCID: PMC5253549 DOI: 10.1136/bmjopen-2016-012133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital. SETTING Acute medical admission units in all NHS Acute Trusts in England. PARTICIPANTS We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1-2 nights, so as to isolate the experience delivered during the acute admission process. PRIMARY AND SECONDARY OUTCOME MEASURES We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected 'being treated with respect and dignity' and 'pain control' as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters. RESULTS The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors. CONCLUSIONS When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between Trusts and should prompt further research to explore if more discriminant surveys can be developed.
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Affiliation(s)
- Paul Sullivan
- NIHR CLAHRC for Northwest London, Imperial College, London, UK
| | - Derek Bell
- NIHR CLAHRC for Northwest London, Imperial College, London, UK
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Pietrantonio F, Orlandini F, Moriconi L, La Regina M. Acute Complex Care Model: An organizational approach for the medical care of hospitalized acute complex patients. Eur J Intern Med 2015; 26:759-65. [PMID: 26365373 DOI: 10.1016/j.ejim.2015.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic diseases are the major cause of death (59%) and disability worldwide, representing 46% of global disease burden. According to the Future Hospital Commission of the Royal College of Physicians, Medical Division (MD) will be responsible for all hospital medical services, from emergency to specialist wards. The Hospital Acute Care Hub will bring together the clinical areas of the MD that focus on the management of acute medical patients. The Chronic Care Model (CCM) places the patient at the center of the care system enhancing the community's social and health support, pathways and structures to keep chronic, frail, poly-pathological people at home or out of the hospital. The management of such patients in the hospital still needs to be solved. Hereby, we propose an innovative model for the management of the hospital's acute complex patients, which is the hospital counterpart of the CCM. ACUTE COMPLEX CARE MODEL (ACCM) The target population are acutely ill complex and poly-pathological patients (AICPPs), admitted to hospital and requiring high technology resources. The mission is to improve the management of medical admissions through pre-defined intra-hospital tracks and a global, multidisciplinary, patient-centered approach. The ACCM leader is an internal medicine specialist (IMS) who summarizes health problems, establishes priorities, and restores health balance in AICPPs. CONCLUSIONS The epidemiological transition leading to a progressive increase in "chronically unstable" and complex patients needing frequent hospital treatment, inevitably enhances the role of hospital IMS in the coordination and delivery of care. ACCM represents a practical response to this epochal change of roles.
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Affiliation(s)
| | - Francesco Orlandini
- SC Medicina Interna 1, Ospedale S. Andrea, ASL5 "Spezzino", La Spezia, Italy
| | - Luca Moriconi
- Azienda Ospedaliera S. Giovanni-Addolorata, UOC Medicina 1 per l'Urgenza, Roma, Italy
| | - Micaela La Regina
- SC Medicina Interna 1, Ospedale S. Andrea, ASL5 "Spezzino", La Spezia, Italy
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11
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Affiliation(s)
- John Kellett
- Nenagh Hospital, Department of Medicine, Nenagh, Co. Tipperary, Ireland.
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12
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Affiliation(s)
- Declan Byrne
- Department of Medicine, Kerry General Hospital, Tralee, Ireland.
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Aliberti S, Kellett J. Where are the acutely ill best cared for and who should look after them? Eur J Intern Med 2011; 22:323. [PMID: 21767745 DOI: 10.1016/j.ejim.2011.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Walters EH, Dawson DJ. Whole-of-hospital response to admission access block: the need for a clinical revolution. Med J Aust 2010; 191:561-3. [PMID: 19912090 DOI: 10.5694/j.1326-5377.2009.tb03312.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 08/26/2009] [Indexed: 11/17/2022]
Abstract
The major problem of access block to acute hospital admissions in Australia needs a more radical response than a focus on increasing inpatient beds, as suggested recently. Australia needs to take on board recent changes in United Kingdom hospital systems, which have revolutionised patient flow during acute admissions and dramatically improved efficiency, clinical quality and outcomes. Accident and emergency departments in the UK became recognised as part of acute hospital dysfunction. Now, increasingly, patients needing admission are directed as soon as possible to an acute medical assessment and admission unit (AMAAU), thus freeing accident and emergency staff for re-defined core priorities. AMAAUs require supervision by a new style of acute general physician, who drives timely management of acute medical patients, defines patient needs, estimates the likely date of discharge, and selects the most appropriate inpatient clinical stream. These reforms are staff-intensive and expensive, but cost-effective and patient-focused. They highlight the need for an adequate scale for acute clinical services and defined streams of care within individual hospitals, as well as explicit networking at a regional level to guarantee specialist acute services when needed.
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Affiliation(s)
- E Haydn Walters
- Discipline of Medicine, University of Tasmania, and Royal Hobart Hospital, Hobart, TAS, Australia.
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Scott I, Vaughan L, Bell D. Effectiveness of acute medical units in hospitals: a systematic review. Int J Qual Health Care 2009; 21:397-407. [DOI: 10.1093/intqhc/mzp045] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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