Acute medical units reduce deaths and stay in hospital, studies show

Care in an acute medical unit—a hospital unit specially designed and staffed for patients with acute medical illnesses—reduces in-hospital mortality and length of stay among people with acute medical conditions, new research indicates.

In 2007, overall mortality in people admitted to an acute medical unit at the Chelsea and Westminster Hospital, London, was 1.1% (28 deaths in 2221 patients). In 2005, before the unit was developed, mortality in patients at the hospital with acute medical illnesses was 1.6% (34 deaths in 2096 patients). The average length of stay was 8.8 days before the unit was developed and 6.9 days afterwards, say audit results reported at the international conference of the Society for Acute Medicine, in London on 29 and 30 September.

Nearly twice as many people were able to go home within 24 hours of going to hospital after the unit was developed (42% (928 of 2221 patients) versus 23% (473 of 2096)). And this did not result in an increase in readmissions. Further results of the study, by Gary Davies, a consultant in respiratory and acute medicine, and Harpreet Lota, a specialty trainee in acute medicine, at Chelsea and Westminster Hospital Foundation Trust, showed that the proportion of patients waiting more than three hours in the emergency department fell from 82% (1963/2402) to 55% (1217/2221).

Dr Davies said, “Our study shows how an organisational change to the service can positively impact on patient care. It provides evidence for the continued development of acute medical units.”

An Australian study reported similar results, with a reduction in the rate of in-hospital deaths among medical patients from 5.6% (188 deaths in 3366 patients) in 2003, before an acute medical unit was set up, to 3.8% (169 in 4422) in 2006, after it was fully functioning (P=0.006). The researchers, from Flinders Medical Centre, Adelaide, found that the fall in mortality occurred despite a 31% increase in the number of acute medical admissions over this time (from 3366 to 4422).

Rhid Dowdle, president of the Society for Acute Medicine, said, “Over the last decade the acute medicine movement has championed improvements in the care of the acutely ill patient in hospital. Most hospitals now have acute medical units supervised by acute physicians, who form the most rapidly growing group of medical specialists in the UK. Research shows the true value of this new way of working, but there is still much more to be done.”

George Alberti, the Department of Health’s clinical director for service reconfiguration, told the conference: “Interest in acute medicine has been rekindled with the realisation that the first few hours in hospital for a person with a medical emergency are critical—and that the patient needs a highly skilled, experienced physician to deal with their acute problem.”

A report published last year by the Acute Medicine Task Force, which was set up by the Royal College of Physicians, recommended that all hospitals that admit patients with acute medical illnesses should set up acute medical units as the focus for acute care (BMJ 2007;335:901, doi:10.1136/bmj.39384.593634.DB). The task force aimed to replace the “see and greet” behaviour sometimes seen in traditional accident and emergency departments with “see and treat.”