scholarly journals 259ASSOCIATION BETWEEN FRAILITY, LENGTH OF STAY AND DISCHARGE DESTINATION IN THE ACUTE MEDICAL UNIT

2016 ◽  
Vol 45 (suppl 2) ◽  
pp. ii13.127-ii56
Author(s):  
Shane Toolan ◽  
Marie Therese Cooney ◽  
Orla Collins
Keyword(s):  
Length Of Stay ◽  
Discharge Destination ◽  
Medical Unit ◽  
Acute Medical Unit

The effect of context on performance of an acute medical unit: experience from an Australian tertiary hospital

2012 ◽  
Vol 36 (3) ◽  
pp. 320 ◽  
Author(s):  
Belinda Suthers ◽  
Robert Pickles ◽  
Michael Boyle ◽  
Kichu Nair ◽  
Justyn Cook ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nursing Home ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Local Context ◽  
Health Staff ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Transfers Of Care

Objective. To ascertain the improvements in length of stay and discharge rates following the opening of an acute medical unit (AMU). Methods. Retrospective cohort study of all patients admitted under general medicine from June–November 2008. Main outcome measures were length of stay in hospital and in the emergency department (ED). Results. The length of time spent in the emergency department for those admitted to the AMU was significantly shorter than those admitted directly to a medical ward (6.83 h v. 9.40 h, P < 0.0001). A trend towards shorter hospital length of stay continued after the AMU opened compared with the same period in the previous year (5.15 days (2.49, 11.57 CI) v. 5.66 days (2.76, 11.52 CI)). However, the number of ward transfers for a patient and the need to wait for a nursing home bed or public rehabilitation affected length of stay much more than the AMU. Conclusion. An AMU was successful in decreasing ED length of stay and contributed to decreasing hospital length of stay. However, we suggest that local context is crucially important in tailoring an AMU to obtain maximal benefit, and that AMUs are not a ‘one size fits all’ solution. What is known about the topic? Acute Medical Units were pioneered in the UK and have been shown to decrease length of stay with no increase in adverse events. As a result, they have been enthusiastically adopted in Australia. However, most studies have been single point ‘before/after’ designs looking at all medical patients, and there has been little consideration of the context in which AMUs operate and how this might affect their performance. What does this paper add? We consider length of stay trends over many years and separate single organ disease from multi-system disease patients, in order to ensure that gains are not simply a result of selective entry of healthier patients into AMUs. We also show that the effect of an AMU is small compared with other systemic issues, such as waiting for nursing home placement and the number of transfers of care. What are the implications for practitioners? Although there may be gains in terms of length of stay in the emergency department, those considering the establishment of an AMU need to consider other factors that may mitigate the improvements in hospital length of stay, such as the roadblocks to discharge, the organisation of allied health staff, and the number of transfers of care.

scholarly journals The Ability of Frailty to Predict Outcomes in Older People Attending an Acute Medical Unit

2013 ◽  
Vol 12 (2) ◽  
pp. 74-76
Author(s):  
Simon Conroy ◽  
◽  
Teresa Dowsing ◽  
Keyword(s):  
Length Of Stay ◽  
Older People ◽  
Odds Ratio ◽  
Canadian Study ◽  
Clinical Frailty Scale ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Frailty Assessment

Background: This study assessed the role of frailty assessment in the AMU. Methods: Patients were assessed for frailty and their outcomes ascertained at 90 days. Results: The Canadian Study on Health and Aging Clinical Frailty Scale categorised 29% of patients as moderately-severely frail. Frailty did not differentially identify those likely to be discharged within one day, nor with long stays. Mortality at 90 days was 32%; frailty was associated with the risk of dying, odds ratio 1.4. 21% of patients were readmitted at 30 days, and 33% at 90 days, but frailty was not predictive. Discussion: Moderate-severe frailty in people aged 70+ was common and was predictive of higher mortality, but did not appear to predict admission, length of stay or readmission.

scholarly journals 272 Clinical Audit on Transient Ischaemic Attack Investigations in Acute Medical Unit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Sylvia Karpinski ◽  
Orla Collins ◽  
Emer Kelly ◽  
Mary Therese Cooney ◽  
Emett McGrath
Keyword(s):  
Length Of Stay ◽  
Waiting Time ◽  
Transient Ischaemic Attack ◽  
Average Length ◽  
Medical Unit ◽  
Average Length Of Stay ◽  
Acute Medical Unit ◽  
Heart Monitoring ◽  
Retrospective Audit ◽  
Ischaemic Attack

Abstract Background TIA (Transient Ischaemic Attack) is a transient episode of neurologic dysfunction. Patients with a TIA have a high early risk of recurrent stroke. These patients need urgent initial evaluation with brain imaging, neurovascular imaging and cardiac evaluation. We conducted retrospective audit in our Acute Medical Unit (AMU) to assess waiting time and type of investigations completed as per TIA guidelines Methods All consecutive admissions with suspected TIAs were evaluated on length of stay, type of imaging tests obtained and how long they awaited for these tests. This was assessed by reviewing discharge summaries, and times and dates of scans on hospital imaging system. Results There was a total of 28 patients admitted to AMU with suspected TIA’s. Of these, 16 were female and 12 were male. Mean age was 70. All patients had CT brain done on admission, two out of 28 had to wait more than 12 hours. 25 out of 28 (89%) patients got US Carotid Dopplers, and two had CT intracranial angiograms. Average waiting time for US Carotid Dopplers was 33 hours, shortest wait was 6 hours and longest was 72 hours. 14 out of 24 (58%) had inpatient heart monitoring (24h telemetry or 24h Holter) two were excluded with known atrial fibrillation, one had PPM in situ and one refused monitoring. Average length of stay in AMU was 3 days. Conclusion Patients admitted to AMU with suspected TIAs had relevant imaging and tests completed as per guidelines. 89 % had US Carotid Dopplers which were on average done 33h from admission. 58% of patients had inpatient heart monitoring. The average length of stay was 3 days but three patients stayed in AMU for up to 5 days. Protected imaging slots for AMU would expedite investigations and reduce inpatient stay.

scholarly journals Acute medical unit clinical skills lab

2019 ◽  
Vol 6 (Suppl 1) ◽  
pp. 140-140
Author(s):  
Sarb Clare ◽  
Joe Wheeler
Keyword(s):  
Clinical Skills ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Skills Lab

scholarly journals Causes of discharge delays from the acute medical unit (AMU) in a tertiary level teaching hospital, Brunei Darussalam

2021 ◽  
pp. 201010582110061
Author(s):  
Dayang Nur Hilmiyah binti Awang Husaini ◽  
Justin Fook Siong Keasberry ◽  
Khadizah Haji Abdul Mumin ◽  
Hanif Abdul Rahman
Keyword(s):  
Observational Study ◽  
Discharge Planning ◽  
Patient Factors ◽  
Medical Unit ◽  
Prolonged Length ◽  
Acute Medical Unit ◽  
Brunei Darussalam ◽  
Medical Issues ◽  
Hospital Factors ◽  
Prolonged Hospital

Background: Many patients admitted to the acute medical unit experience a prolonged length of stay in hospital due to discharge delays. Consequently, this may impact the patients, healthcare institution and national economy in terms of patient safety, decreased hospital capacity, lost patient workdays and financial performance. Objectives: The main aim of this observational study was to identify the causes of discharge delays among acute medical unit patients admitted in the Raja Isteri Pengiran Anak Saleha Hospital, Brunei. Methods: A retrospective observational study, with data of patients admitted to the acute medical unit collected from Brunei Health Information Systems between September and December 2018. Statistical analyses were performed to obtain relevant results and any statistically significant associations. Results: A total of 357 patients were admitted to the acute medical unit over the 4-month period; 218 patients (61.1%) experienced discharge delays. Of these 218 patients, 158 patients (72.5%) encountered discharge delays mainly due to intrinsic patient factors, while the discharge delays in 88 patients (40.4%) were attributed to hospital factors. The main reason for discharge delays for patient factors was slow recovery among 67 patients (30.7%), whereas for hospital factors it was the weekend limitation of services available in 23 patients (10.6%). Conclusions: There were various causes of discharge delays identified among the 218 acute medical unit patients who experienced discharge delays. Older patients with frailty, polypharmacy and complex medical issues were more likely to have a prolonged hospital stay in the acute medical unit. Stringent inclusion criteria, increasing discharge planning as well as an effective multidisciplinary approach will aid in reducing discharge delays from the acute medical unit.

Prevalence of signs of dysphagia and associated risk factors in geriatric patients admitted to an acute medical unit

2021 ◽  
Vol 41 ◽  
pp. 208-216 ◽  
Author(s):  
Maria Dissing Olesen ◽  
Robert Mariusz Modlinski ◽  
Simon Hosbond Poulsen ◽  
Pernille Mølgaard Rosenvinge ◽  
Henrik Højgaard Rasmussen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Geriatric Patients ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Associated Risk Factors

scholarly journals Acute medical unit staffing mismatch

2019 ◽  
Vol 6 (Suppl 1) ◽  
pp. 44-44
Author(s):  
Dominic Reynish
Keyword(s):  
Medical Unit ◽  
Acute Medical Unit

Socialising Disease: Medical Categories and Inclusion of the Aged

2000 ◽  
Vol 48 (3) ◽  
pp. 383-407 ◽  
Author(s):  
Joanna Latimer
Keyword(s):  
Older People ◽  
Hospital Care ◽  
Social Inclusion ◽  
Social Problems ◽  
Older Person ◽  
Medical Unit ◽  
Life Chances ◽  
Acute Medical Unit ◽  
Medical Domain

When older peoples' troubles are categorised as social rather than medical, hospital care can be denied them. Drawing on an ethnography of older people admitted as emergencies to an acute medical unit, the article demonstrates how medical categories can provide shelter for older people. By holding their clinical identity on medical rather than social grounds, physicians who specialise in gerontology in the acute medical domain can help prevent the over-socialising of an older person's health troubles. As well as helping the older person to draw certain resources to themselves, such as treatment and care, this inclusion in positive medical categories can provide shelter for the older person, to keep at bay their effacement as ‘social problems'. These findings suggest that contemporary sociological critique of biomedicine may underestimate how medical categorising, as the obligatory passage through which to access important resources and life chances, can constitute a process of social inclusion.

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