Acute medicine clinics: the pathway to earlier discharge?

Michelle Cooper

doi:10.7861/clinmedicine.19-2-s88

Aims

To determine if the introduction of new acute medicine urgent access clinics in December 2017 have enabled doctors to discharge patients earlier from the acute medical take / acute medical unit (AMU).

Methods

A questionnaire was distributed to medical doctors (consultants/registrars/senior house officers; Fig 1) to determine whether they believed that the introduction of the new acute medicine urgent access clinic has supported them to:

discharge patients from the acute take earlier
expedite discharges from the emergency department (ED) that otherwise would have been admitted under medicine
expedite discharges from the post-take ward round (PTWR)
expedite discharges from AMU.

Fig 1.

Grade of doctor completing survey.

Results

Ninety-three percent of doctors felt the introduction of the new acute medicine urgent access clinic in December 2017 has allowed them to discharge patients from the acute take earlier (Fig 2).

Seventy-seven percent believe the clinic has helped expedite discharges from ED who otherwise would have been referred for admission under medicine (Table 1).
Seventy-nine percent believe the clinic has helped expedite discharges from the PTWR (Table 1).
Eighty-seven percent believe the clinic has helped expedite discharges from AMU (Table 1).

Fig 2.

Results from the acute medicine clinic and earlier discharge.

View this table:

Table 1.

Survey results

Conclusion

The vast majority of doctors felt that the introduction of acute medicine urgent access clinics have resulted in expedited discharges from the acute medical take. Given the recent winter pressures that have gravely impacted not only Warrington Hospital, but hospitals nationally with deferral of all non-urgent inpatient elective care and routine operations in January 2018,¹ this is an important step to improve the current bed pressures. Furthermore, with the establishment of these clinics, Warrington Hospital is now striving towards the Future Hospital Commission's vision of ‘care focused on prevention and recovery’ which states: ‘Patients should only be admitted to hospital if their clinical need requires it… Hospitals should promote ways of working that allow emergency patients to leave hospital on the same day’.² The new clinic provides an alternative avenue for patients, allowing early outpatient review as opposed to hospital admission. Less than 1% of patients have required admission directly from the clinic, demonstrating that patients are being selected and managed appropriately for review as an outpatient in the acute clinic. We plan to review admission rates on the acute medical take and length of stay on AMU in the coming months to see if there has been any change since the introduction of the clinics, and publish the results.