Abstract

Background: The absence of published data for benchmarking serves as a disincentive for Acute Medical Units to improve care.

Aim: To test feasibility of a national audit in Acute Medicine for compliance with common standards

Methods: On line questionnaire with summary data for patients admitted to participating Acute Medicine Units over a 24-hour-period.

Results: 30 units submitted summary data. The mean number of admission was 36 (SD 14). Compliance with standards around timing of junior and senior review was highly variable. In almost all other standards only a small number of units achieved high reliability with compliance of more than 90%.

Conclusion: SAMBA provides a data set that can be used for local and national benchmarking and quality improvement work. Annual audit might be beneficial to track improvements.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Prytherch DR, Smith GB, Schmidt PE, et al. ViEWS--Towards a national early warning score for detecting adult inpatient deterioration. Resuscitation 2010; 81(8): 932-7.
2. Kellett J, Deane B. The Simple Clinical Score predicts mortality for 30 days after admission to an acute medical unit. Q J Med 2006; 99(11): 771-81.
3. Silke B, Kellett J, Rooney T, et al. An improved medical admissions risk system using multivariable fractional polynomial logistic regression modeling. Q J Med 2010; 103(1): 23-32.
4. Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Maryland State Medical Journal 1965; 14: 56-61.
5. Katz S, Down, TD, Cash HR, et al. Progress in the development of the index of ADL. The Gerontologist 1970; 10(1): 20-30.
6. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173(5): 489-95
7. The Society For Acute Medicine. Clinical Quality Indicators for Acute Medical Unit. http://www.acutemedicine.org.uk/index.php?option=com_content&view=article&id=81:acutecare-quality-and-performance-indicators&catid=72:positionstatements&Itemid=30 (accessed on 15th January 2012)
8. Nolan T, Resar R, Haraden C, et al. Improving the Reliability of Health Care. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2004.
9. Subbe CP, Gauntlett W, Kellett JG. Collaborative Audit of Risk Evaluation in Medical Emergency Treatment (CAREMET I) - an international pilot. Eur J Intern Med. 2010; 21(3):222-5.
10. Fit for the Future? Dr Foster Hospital Guide 2012. Dr Foster ltd.
11. National Institute for Health and Clinical Excellence. Clinical Guideline 50. Acutely Ill Patients in Hospital. London 2007.
12. National Institute for Health and Clinical Excellence. Clinical Guideline 68. Diagnosis and Initial Management of Stroke and Transient Ischemic Attack (TIA). London 2008.
13. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003; 58: 470-484.
14. Scottish Intercollegiate Guidelines Network. Guideline 105: Management of acute upper and lower gastrointestinal bleeding. Edinburgh 2008.
15. Guy, H. Pressure ulcer risk assessment and grading. Nursing Times 2007; 103: 38-40.
16. National Institute for Health and Clinical Excellence. Clinical Guideline 29: The management of pressure ulcers in primary and secondary care. London 2005.