Hospital Dr News

Acute admissions unit in Watford shows way

A next generation acute admissions unit – one of the largest in the UK – has cut death rates and the time patients stay in hospital since it opened in March.

Early figures show that the average length of stay at the 120-bed unit at Watford General Hospital has fallen by 1.9 days to 5.4. Standardised mortality ratios and readmission rates have also fallen.

But the success of the unit in fast tracking patients is putting pressure on other hospital departments where the throughput of patients is slower.

The unit, created as part of a reconfiguration of acute services by West Hertfordshire Hospitals Trust, enables patients admitted as an emergency to be seen and assessed rapidly by a consultant. 

The consultant physician on duty can readily access specialists in respiratory medicine, cardiology, neurology, gastroenterology and rheumatology, who visit the unit regularly.

The unit houses state of the art diagnostic equipment, two new cardiac catheterisation laboratories and a modern pharmacy department with a robotic dispensary. A short stay ward enables patients to be monitored for 48 hours.

“This model is becoming increasingly used by NHS trusts for obvious reasons and it really is the way to deliver acute services and acute care,” said the trust’s medical director Dr Colin Johnston.

The unit is run by a team of three acute care physicians who do the early morning ward rounds then deal with new admissions that arrive in the morning. A specialty ‘physician of the day’ works a shift from 1-9 pm and is on call for the rest of the night. At weekends consultants will work 9am to 9pm, seeing patients as they come in.

The rapid turnover of patients has put pressure on staff. Johnston said: “People are having to work very hard in the unit. Patients are coming through all the time and there is a lot of pressure to see people and triage them quickly. It is tough on consultants, particularly the more senior ones who are not used to this intensity of work. It has been a big change.”

He predicts that over time younger physicians will do more of this intense acute work, using it to gain experience before moving into their specialty interest.

The unit does, however, put pressure on other departments. “The real problem at the moment is with the efficiency of the main part of the hospital,” he said. “We have put on so much intensity at the front end while at the same time there is a big demand on consultants at the back end for specialty work and to make sure we are achieving the 18-week and outpatient targets. We simply don’t have enough consultants.”

But Johnston said the PCT is not keen to see expansion in the consultant workforce in the acute sector when policy is to move more services out in to the community.

He said: “The long term success of the unit depends on joining up all the other issues and making sure we have got the community care, the adult care services and all the other agencies that need to be working with us in place. There is a still a lot to be done.”

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