Hospital Dr News

Safe consultant cover in AMU – new guidance

A royal college ‘toolkit’ has set out how seven-day-a-week consultant cover in acute medical units should be organised.

The toolkit provides practical guidance to senior hospital managers and clinical staff on how to organise acute medical services to ensure 12-hour consultant presence per day, which is required for consistent high quality care to acutely ill patients.

It suggests consultants should work shifts of between eight and 12 hours for at least two consecutive days.

The Royal College of Physicians has worked with the Society of Acute Medicine on the project aimed at implementing their joint proposal for seven-day-a-week working by consultants. They developed the toolkit because acute medical illness is a seven day problem – patients are just as likely to develop an acute illness requiring an emergency admission on a Saturday or Sunday as on a weekday.

Evidence that patients admitted at weekends have poorer outcomes than those admitted on weekdays, and that patient mortality is higher at weekends led to the RCP and SAM recommending that a consultant physician dedicated to care of acutely ill patients should be available on site to review patients for at least 12 hours a day, every day.

The guidance says the consultant on duty should see all newly admitted patients within a maximum of six to eight hours, with the provision for immediate consultant review for severely ill patients.

All patients in the AMU should be reviewed twice each day by the AMU consultant or the appropriate specialty team. Most units will require more than one AMU consultant working each day to meet this requirement.

Consultant duties on the AMU should start no later than 8am and the consultant shift should usually be for between 8 and 12 hours. When undertaking clinical duties on the AMU, the consultant should be free from any other specialty, ward or management commitments.

Individual consultants’ duties on the AMU should be for two or more consecutive days; any variation must be specifically designed to optimise the continuity of care provided to patients on the AMU.

Diagnostic and support services should be provided seven days per week, to ensure that the full benefits of consultant delivered-care to patients are realised.

Dr Mark Temple, RCP acute care fellow, said: “Consultant review of acutely ill patients 12 hours a day, seven days a week is key to the delivery of care that is of the highest quality on the acute medical unit (AMU). AMUs together with emergency departments are the busiest clinical areas in the hospital.

“This toolkit provides important new guidance on working practices during the consultant shift on the AMU and the number of patients a single consultant can be expected to review during this shift. Hospitals struggling to cope with increasing emergency admissions, can use the toolkit to reconfigure acute medical services and ensure that daily consultant review is integral to the provision of high quality care to patients with acute illness.”

The guidance includes answers to key questions including:

– How many consultants are required to provide a daily 12 hour presence on the AMU?

– How many patients should a consultant be expected to review during their shift on the AMU and how long should this shift be?

– How should consultant working and support services be organised in order to provide high quality patient care every day of the week?

Dr Chris Roseveare, president of the Society of Acute Medicine, said: “Clinicians and managers now have the opportunity to calculate the workforce which they will require to deliver this, based on factors such as the size and configuration of the AMU, as well as the numbers of patients admitted on a daily basis. This is a landmark in acute medical care and represents a major step forward for the treatment of patients admitted to hospital in an emergency.”

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One Response to “Safe consultant cover in AMU – new guidance”

  1. Malcolm Morrison says:

    Obviously, excellent advice; but some would say “Not before time”! It is hardly world-shattering news for the RCP (and SAM) to announce ” patients are just as likely to develop an acute illness requiring an emergency admission on a Saturday or Sunday as on a weekday”! Junior doctors have been aware of this all along!

    It is obviously an improvement to have a consultant ‘present’ for 12 hours per day; but I presume there will also be a consultant ‘on call’ for the other 12 hours – during which patients can still get sick! And ’24hr cover’ means 168hrs per week; each is only permitted, under EWTRs, to work 48hrs; this equals 3.5 consultants – and does not take account of holidays and sickness. So, it is going to be expensive!

    Will the RCP be recommending the closure of any ’emergency service’ that does NOT meet these standards? If not, why not? Surely it is ‘in the best interests of patients’ to have such standards? Should patients expect no less?
    Retired Orthopod

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