Patients have better outcomes and are less likely to be readmitted to hospital if they’re cared for by acute physicians, a study finds.
A survey of over 100 hospitals in England by the Royal College of Physicians shows that Acute Medical Units improve care the most when acute medics are have no other routine duties during that time; perform regular ward rounds and are often present on the ward.
The RCP is now recommending this system of acute medical cover.
The survey was commissioned by the RCP in association with the Society for Acute Medicine and the British Geriatrics Society, which helped develop and distribute the survey. It matched various systems of consultant cover against patient outcome data from hospital episode statistics, to see if there was an advantage to patient care from any of the different systems.
Dr Chris Roseveare, president of the Society for Acute Medicine, said: “This study represents a really important step forward in the management of patients admitted as medical emergencies.
“For the first time, specific patterns of consultant working on the Acute Medical Unit have been shown to be associated with improved patient outcomes; hospitals now have a fantastic opportunity to identify the number of acute medicine consultants required to deliver best practice and to provide sustainable rotas for 7 day working in acute medicine.”
The research shows that hospitals in which admitting consultants have no other fixed clinical commitments while on acute take had a lower adjusted case fatality rate, and when consultants work blocks of more than one day on call there was lower excess weekend mortality.
Furthermore, hospitals in which there were two or more AMU ward rounds per day reviewing all patients on the unit had a lower adjusted case fatality rate for patients with a hospital length of stay of more than seven days. And hospitals where the admitting consultant was present for more than four hours for seven days per week had a lower 28 day readmission rate.
While some hospitals are already using the system described above, the survey also showed that many hospitals were operating other patterns of care with poorer outcomes, in particular most trusts are still using ‘consultant of the day’ instead of the recommended ‘consultant of several days’.
Additionally, in almost half of the hospitals, the first consultant on call undertakes other routine clinical duties while managing the acute take as opposed to being dedicated to the acute take. And often acute medical patients are only reviewed once daily by a consultant, not twice daily.
Dr Kevin Stewart, clinical director of the RCP’s clinical effectiveness and evaluation unit, said: “The profile of acute medical patients has changed dramatically over the past 20 years, yet in some hospitals changes in consultant working patterns have been much slower. Traditional rotas are neither safe for patients, nor good for clinicians. Now, patients are older, sicker and have more complex conditions, and they require dedicated consultants to be available on site 7 days per week for at least 12 hours a day.”
The research supports the RCP’s recent call for consultant physicians to be on site for 12 hours per day, seven days a week.
Dr Simon Conroy, British Geriatrics Society, said: “We welcome the findings of the report, which emphasises the importance of getting frail older people seen at the earliest possible opportunity in their admission to maximise outcomes.”