An audit of medical outliers in a north Wales district ­general hospital

Hayley Evans; Vedamurthy Adhiyaman

doi:10.7861/futurehosp.4-2-s13

Aims

The aim of the project was to investigate the number of medical outliers in the hospital and assess whether they received appropriate care.

Methods

This was a prospective audit over a 5-day period (26–30 September 2016) of all patients under a medical team who were admitted to a non-medical ward. Patients who were waiting for a bed in the emergency department for more than 4 hours after having been reviewed by the consultant on the post-take ward round were classed as medical outliers.

Results

The audit identified 51 individual patients who were classed as medical outliers during the 5-day period, with an average of 23.8 outlying patients per day. Medical patients were outlied to all non-medical adult wards in the hospital, including the emergency department and its attached observation unit, surgical assessment unit, surgical wards and gynaecology ward. The length of stay in the emergency department (ED) ranged from 6 hours to 4 days; the length of stay in non-ED wards ranged from 1 day to 6 months. Eight episodes were identified where patients did not have a daily review. The case notes were unavailable or delayed in being retrieved for seven patients. Nineteen patients were identified as not being under the correct consultant team on the hospital computer system.

Conclusions

The present audit demonstrates that the hospital has a significant number of medical patients outlying on a non-medical ward on any given day; keeping track of the patients can be problematic, as they are often not listed under the correct consultant and subsequently the patients are less likely to receive the same standard of care that they would receive if they were admitted to a medical ward. The audit has informed clinical practice and suggests that the current provision for medical patients in this hospital in terms of beds is not sufficient and can lead to unsafe care.