An Evaluation of Consultant Input into Acute Medical Admissions Management in England, Wales and Northern Ireland

In 2010 SAM collaborated with RCP London to produce this report on the organisation of services for managing Acute Medical Admissions.

Key Findings

The vast majority of hospitals (123 out of 126) surveyed have an established AMU.

Most hospitals (88%) have a recognized clinical lead for acute medical admissions, and a large proportion of these (70%) work on a regular basis in the AMU on most weekdays.

Most hospitals (83%) have operational policies in place.

Of the 123 hospitals with AMUs, 86% have level 1 facilities embedded within the unit with 39% of larger hospitals having access to level 2 facilities within the unit.

Less than half of hospitals (44%) have an arterial blood gas machine within the AMU, which means that agreed response turnaround times from laboratories should be in place to meet current recommendations. However a quarter, (26%) have neither a machine nor agreed lab response times.

Only 2 sites do not appear to have an EWS system in place and, in the majority (93%), this is now part of the routine first assessment in hospital, in agreement with national recommendations.

All AMUs have direct involvement of the main medical specialties on the acute take, although as expected, involvement is less common for rheumatology, nephrology, dermatology and oncology. Support medical specialty input is approximately the same at weekends as during the week.

Consultant patterns of working still reflect ‘Consultant of the day’ in most (91%) trusts rather than the recommended ‘Consultant of several days’. Consultant of the week is the least common working pattern (6%). Unfortunately in 48% of the hospitals surveyed, the consultant on-call still undertakes other routine clinics or procedures while managing the acute take; in only 52% of hospitals do consultants routinely cancel other duties in line with recommendations. In only 49% of hospitals are patients routinely seen twice per day within the AMU, 7 days a week. But, other hospitals offer continuous review as an alternative in addition to ward rounds.

Eighty five percent of the surveyed sites now employ Acute Physicians, and on average these sites have 3 in post, Most commonly, acute physicians work extended days (9 – 12 hours) in the AMU. The minority of acute physicians work at weekends; 73% work zero continuous hours at weekends.

In only 47% of hospitals, the Acute Physicians are integrated into the same on-call system with the same frequency as other participating consultants, and of concern is the fact that a few have no first line responsibility for managing patients.

To read the full report click here