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Tweets on how AMUs can deliver a higher quality service

Four twitter debates about how AMUs (acute medical units) can deliver a high quality professional  service were held during the recent Acute Medicine Awareness Week supported by the Society for Acute Medicine.

Here are some of the highlights:

How can we ensure a 7 day multi-professional service on the AMU?

· ‘8-8 7/7 and secured 2nd cons for mornings at w/e to see any patients downstream that need it. V dependent on non-acute cons input’

· ‘We have consultant presence 8-8 mon-fri but at weekends there is no cover from midday – 1700′

·We manage 9 hours 7/7, need more consultants to cover longer’

·Interested in people’s current barriers to 7/7 work. Not enough acute cons yet? Not enough gen med cons buy in? Too expensive?’

· ‘We never seem to have enough junior doctors!’

· ‘We need to emphasise that 7/7 working does not mean working 7 days every week – just a different 5 days’

· ‘Difficult balance between consultant delivered care, continuity and some reluctance to do >24 hours ‘on-take’

· ‘Discharge rounds great if cons led. We found regs don’t discharge anything like the same number as the consultants – confidence?’

Conclusion: A whole team approach to 7-day working on the AMU is vital – needs to involve all members of the MDT + good access to diagnostics

How can we improve patient experience on the AMU?

· ‘pts need to be seen quickly & with as much communication as possible, including to family & ongoing team’

· ‘I like the ‘senior at the door’ approach (worked a variety of systems) Best communication & plan to pt & team upfront’

· ‘Communication is clearly a key issue for patient experience – how do we ensure this is done well in the busy AMU?’

· ‘I would put empathy high on list and keeping patient informed is v important’

· ‘the priority should not be ticking boxes, certainly have a routine but remember pt is a human’

· ‘I often find delivering quality care compressed into 15 minutes per patient challenging’

· ‘I think we need more nurses on the ward rounds like in the old days they are a huge part of good communication’

· ‘things like kindness, wearing a smile. These simple & straightforward things makes a patient feel they are important’

Conclusion: Improving communication is clearly important in improving patient experience on AMU

‘How can deliver high quality training and education on the acute medical unit?’

· ‘from my experience students love it, junior docs work too hard to appreciate any more than a chance to do wba (work based assessment)’

·I suggest everyone uses the keep record option on eportfolio so know what you’ve done’

· ‘All assessments should have an mdt (multi disciplinary team) approach as the AMU only functions well if a team approach used joint learning with no blame’

· ‘depends if they recognise learning arising through work activity i.e. not being taught per se’

· ‘formal teaching often difficult to deliver in the AMU due to time constraints, but lots of opportunities to learn’

· ‘toolkit (Royal College of Physicians) v useful & full of common sense. Can’t release staff for training so need to max resources on AMUs, with MDT too’

Conclusion: High quality education and training is important on the AMU

How can we deliver and measure quality on the AMU?

· ‘Quality measures should be 1) measurable (accurate, acceptable, reproducible etc) and 2) meaningful (amenable to change, important)’

· ‘Whenever we talk about quality in healthcare it should reflect a positive patient experience’

· ‘How staff feel about care given is an important part of patient experience too’

· A patient may have the best care available, but if it’s not communicated to them (&family) it may not be perceived as good care’

· ‘it’s all very well setting targets but who here has any time to measure them? Should it be job planned into work?’

· ‘take a leaf out of ED? Computerised pt tracking from time of admit to discharge to ward. Software already exists’

· ‘Need to be careful QIs (quality indicators) don’t turn into clock watching. No bigger compromise of patient care than that’

· ‘think we need to look at trainee experience F1-SpR. A good, happy AMU will produce good, happy trainees’

Conclusion: Consistent and simple quality data collection is clearly important, but addition of patient experience measure should be considered.

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