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Dr Dan Beckett Consultant Acute Physician NHS Forth Valley Slide 2 National recommendations for AMUs RCP Acute Medine Taskforce Report Recommendations to improve flow The current national picture Outcome data AMU Quality Indicators Slide 3 RCP Acute Medicine task force recommendations published 2007 Blueprint for development of acute medical services Slide 4 All hospitals admitting patients with acute medical illnesses should establish AMUs as the focus for acute medical care The AMU should operate a number of streams for patients related to clinical need Acutely unwell (level 1/2) Short stay Ambulatory Complex needs patients Slide 5 Transfer of care planning should begin at the time of initial patient assessment...and an estimation of anticipated length of stay should be recorded for all patients within 12 hours of admission Where patients require in-patient care within the specialty bed base there should be no barriers to patient transfer... Slide 6 Patient Assessment 24 HR 24 - 48 HRS Specialty Ward Transfer ASAP if LOS > 48-72hrs Multi- disciplinary Team Stay Diagnostic uncertainty Mobilisation Care package Slide 7 GP/A+E 40% Home 36% RIE 24% O/S LOS ~ 48hrs OTPCPPTNursePharm Slide 8 The length of stay on an AMU should be dictated by clinical need and not arbitrary limits Typical LOS 24-72 hours Mean LOS 24-30 hours in established units Patients should be pulled rather than pushed Slide 9 Take day off clinically unnecessary LoS and it has a dramatic impact Alternatives to admissionThese patients may have more complex support needs Left shift Slide 10 An adequately sized and staffed AMU should aim for a significant percentage (about 50%) of acute medical admissions to complete their episode of care within the AMU As a guide to size the minimum number of beds will be equivalent to the number of patients admitted over 24 hours plus 10% Slide 11 There should be twice-daily, consultant-led ward round/review of all patients in the AMU, seven days per week The physician of the day model is strongly discouraged as this is not conducive to continuity of care We recommend dedicated blocks of work on the AMU and cancellation of other commitments Slide 12 We recommend new models of working that are predicated on ensuring adequate levels of competent clinical decision makers are present on the AMU and other front-line services 24/7. Specialty teams should...provide advice or attend and review patients expeditiously on the AMU within a maximum of 4 hours of a request, or ideally sooner Slide 13 The pace of life in the main hospital bed base beyond AMU must be geared to respond dynamically to changes in demand so as to increase capacity during busy periods Real time monitoring of demand and capacity Robust escalation policies Daily clinical review of the entire bed base by a competent clinical decision maker Slide 14 Survey of 126 Acute Hospitals in England, Wales and Northern Ireland October 2010 Audit against national guideline standards on service organisation and staffing arrangements Slide 15 Number of hours admitting consultant continuously present Weekday 9 12 hours 49% >12 hours 13% Weekend 9 12 hours 16% > 12 hours 4% Admitting consultants available for fewer hours at the weekend Slide 16 All admissions4,317,8664.9 (162,639) 5.2 (52,415)