Philip Dyer

Summary

Following the establishment of a medical review clinic in an Emergency Assessment Area (EAA) the reasons for and the appropriateness of referral of patients after initial visit were prospectively analysed in 167 patients. An attempt was also made to establish the number of patients who would have been admitted if the clinic were not in place and thus the potential saving of bed-days from this new initiative. Three main reasons for referral were the uncertainty about diagnosis, uncertainty about management and the review of outstanding investigations. Fifteen per cent of patients were judged to have been inappropriately referred. In 22% of patients the presence of the clinic prevented hospital admission and it was also felt that in a further group of patients the clinic provided a useful role in reassuring the patient, reinforcing and reviewing management plans. The clinic also acted as an educational tool for junior doctors. Thus the development of an early review clinic in an Acute Medical Unit / EAA setting is a useful adjunct to the delivery of high quality ambulatory patient care.