Performance of admission pathways within acute medicine services: Analysis from the Society for Acute Medicine Benchmarking Audit 2022 and comparison with performance 2019 - 2021.

Autor: Atkin C; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2GW, UK. Electronic address: c.atkin@nhs.net., Knight T; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2GW, UK., Cooksley T; Departments of Acute Medicine, Manchester University NHS Foundation Trust, M23 9LT and The Christie, Manchester M20 4BX, UK., Holland M; Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, BL3 5AB, UK., Subbe C; School of Medical Sciences, Bangor University & Consultant Acute, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, Bangor LL57 2PW, UK., Kennedy A; Department of Acute Medicine, Airedale Hospital NHS Foundation Trust, West Yorkshire, Keighley BD20 6TD, UK., Varia R; Department of Acute Medicine, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot L35 5DR, UK., Gebril A; Department of Acute Medicine, Salford Royal, Northern Care Alliance NHS Foundation Trust, Salford, Manchester M6 8HD, UK., Lasserson D; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Division of Acute General Medicine, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford OX3 9DU, UK.
Jazyk: angličtina
Zdroj: European journal of internal medicine [Eur J Intern Med] 2023 Dec; Vol. 118, pp. 89-97. Date of Electronic Publication: 2023 Aug 04.
DOI: 10.1016/j.ejim.2023.07.038
Abstrakt: Urgent and emergency care services face increasing pressure, impacting patient care. We evaluated the performance of acute medicine services, assessing clinical quality indicators for unplanned medical admissions to acute hospital services. 152 acute UK hospital services accepting unplanned admissions to acute and general internal medicine completed a day-of-care survey incorporating organisational structure questionnaire and patient-level data over a pre-defined 24-hour period in June 2022. Clinical quality indicators were: Early Warning Score (EWS) measurement within 30 min of hospital arrival; clinician assessment within 4 h; assessment by consultant physician within 6 h (daytime) or 14 h (night-time). Results were compared with 2019, 2020, 2021. 7293 sequential patients were included (and compared with 19,817 patients across 2019-2021). In 2022, 69% of patients (95%CI 67.7-69.9%) had an EWS documented within 30 min. 79% of patients (95%CI 77.8-79.7%) were reviewed by a clinical decision maker within 4 h of hospital arrival. Patients assessed in Same Day Emergency Care services were more likely to meet this target than those assessed in Acute Medical Units or Emergency Departments (OR 2.4, 95%CI 2.02-2.87, p<0.001). Overall, 50% of patients received consultant physician review within the target time (3065/6161, 95%CI 48.5-51.0%); performance varied with time of arrival and location of initial assessment. Performance against all three clinical quality indicators was lower than 2019, 2020 and 2021 (p<0.001 for all). Performance against all quality indicators within acute medicine services is deteriorating. However, performance in Same Day Emergency Care Units is greater than in Acute Medical Units or Emergency Departments.
Competing Interests: Declaration of Competing Interest All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; CA is funded by an NIHR clinical lectureship. DSL declares salary support from National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands; no other relationships or activities that could appear to have influenced the submitted work.
(Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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