Presentation is loading. Please wait.

Presentation is loading. Please wait.

Dr Dan Beckett Consultant Acute Physician NHS Forth Valley.

Similar presentations


Presentation on theme: "Dr Dan Beckett Consultant Acute Physician NHS Forth Valley."— Presentation transcript:

1 Dr Dan Beckett Consultant Acute Physician NHS Forth Valley

2  National recommendations for AMUs ◦ RCP Acute Medine Taskforce Report  Recommendations to improve flow  The current national picture  Outcome data  AMU Quality Indicators

3  RCP Acute Medicine task force recommendations published 2007  Blueprint for development of acute medical services

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

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...’

6 Patient Assessment 24 HR HRS Specialty Ward Transfer ASAP if LOS > 48-72hrs Multi- disciplinary Team Stay Diagnostic uncertainty Mobilisation Care package

7 GP/A+E 40% Home 36% RIE 24% O/S LOS ~ 48hrs OTPCPPTNursePharm

8  ‘The length of stay on an AMU should be dictated by clinical need and not arbitrary limits ◦ Typical LOS hours ◦ Mean LOS hours in established units  Patients should be ‘pulled’ rather than pushed

9 Take ½ day off clinically unnecessary LoS and it has a dramatic impact Alternatives to admissionThese patients may have more complex support needs Left shift

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%’

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’

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’

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’

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

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

16 All admissions4,317, (162,639) 5.2 (52,415) <0.001 ** Acute renal failure (CCS 157)14, (2,924) 33.3 (909)<0.001 ** Acute cerebrovascular disease (CCS 109)70, (14,451) 30.2 (5,437) <0.001 ** Acute myocardial Infarction (CCS100)68, (6,803) 14.4 (2,650) 0.002* Cardiac arrest and ventricular fibrillation (CCS 107)2, (1,238) 68.1 (455)0.048* Cardiac dysrhythmias (CCS 106)86, (1,270)2.4 (453)<0.001 ** Chronic obstructive pulmonary disease and bronchiectasis (CCS 127) 106, (6,174)7.6 (2,005)0.840 Congestive heart failure non hypertensive (CCS 108)56, (7,944) 19.6 (2,351) <0.001 ** Coronary atherosclerosis and other heart disease (CCS 101)91, (1,676)2.8 (583)0.008* Fluid and electrolyte disorders (CCS 55)17, (1,359)11.3 (365)0.013* Gastrointestinal haemorrhage (CCS 153)57, (3,196)7.8 (1,087)0.042* Liver disease, alcohol-related (CCS 150)10, (1,576) 20.4 (382)0.042* Pneumonia ( CCS 122)102, (18,619) 25.4 (6,574) Pulmonary heart disease (CCS 103)16, (1,200)11.0 (349)0.046*

17  Proportion of sites providing at least twice daily ward round ◦ Weekday 61% ◦ Weekend 69%  However ward rounds at the weekend less likely to see all patients in AMU and more likely to see only new patients, or those thought to be unwell or possible discharges

18  91% of sites still operate a physician of the day receiving model, augmented by the presence of Acute Physicians  48% of sites report that consultants with first-on responsibilities still undertake other duties during the acute take (eg out-patient clinics)

19  Mortality rates ◦ Within 48 hours of admission ◦ HSMR ◦ Weekend vs Weekday mortality rates ◦ In-hours ( ) vs Out of hours  Direct discharge rates within 24 or 48 hours of admission  7 day readmission rate  Intermittent audit of tracker conditions  Patient experience

20  Acute Medical Care: The right person, in the right setting, the first time. RCP Acute Medicine Task Force Report 2007  RCPE UK Consensus Statement on Acute Medicine, November 2008


Download ppt "Dr Dan Beckett Consultant Acute Physician NHS Forth Valley."

Similar presentations


Ads by Google