RT Journal Article
SR Electronic
T1 Process of care and activity in a clinically inclusive ambulatory emergency care unit: progressive effect over time on clinical outcomes and acute medical admissions
JF Future Healthcare Journal
JO Future Healthc J
FD Royal College of Physicians
SP 234
OP 240
DO 10.7861/fhj.2019-0062
VO 7
IS 3
A1 Michael E Reschen
A1 Jordan Bowen
A1 Sudhir Singh
A1 Mridula Rajwani
A1 Matthew Giles
A1 James Price
A1 Daniel Lasserson
A1 Christopher A O'Callaghan
YR 2020
UL http://www.rcpjournals.org/content/7/3/234.abstract
AB Clinically relevant outcomes for same-day emergency care provided by ambulatory emergency care units (AECs) are largely unknown. We report the activity and outcomes for a large UK adult AEC operating an ambulatory-care-by-default model without specific exclusion criteria.The AEC consultant triaged all acute medical referrals to either the AEC or the standard non-ambulatory ‘take’ pathway during AEC opening hours.The proportion of acute medical referrals seen in the AEC increased to 42% (mean 700 referrals seen per month) in the last 6 months of the study and numbers seen in the non-ambulatory pathway fell. The most common diagnoses were for chest pain, pneumonia, cellulitis, heart failure and urinary system disorders. Seventy-four point eight per cent of patients completed their care in a single visit. In the last calendar year, the conversion rate from AEC to inpatient admission was 12%, and the 30-day readmission rate was 6.9% and 18% for the AEC and non-ambulatory pathways, respectively. Across the whole study period, the 30-day mortality was 1.6% and 6.9% for the AEC and non-ambulatory pathway, respectively.This ambulatory approach is safe and effective.