Medical Admissions

Acute care service performance during winter: report from the winter SAMBA 2020 national audit of acute care

Original Articles, Volume 19, Issue 4, Pages 173 – 252 (2020)

The Winter Society for Acute Medicine Benchmarking Audit (SAMBA) provides the first comparison of performance within acute medicine against clinical quality indicators during winter, a time of increased pressure and demand on acute services.

105 hospitals participated in Winter SAMBA, collecting data over 24-hours on 30th January 2020. 5626 patients were included. Participating units saw a median of 48 patients (range 13-131).

Comparison between Winter SAMBA and SAMBA19 found less patients had an early warning score within 30 minutes during winter (74.3% vs 78.9%) and less were seen by a clinical decision maker within four hours (84.9% vs 87.9%). Unplanned admissions represented a higher proportion of workload (92.5% vs 90.1%). Patients were more likely to have a NEWS2 score of 3 or higher (30.1% vs 25.7%).

Performance is poorer in winter, and patients are more unwell, needing prompt treatment. Services should ensure high quality care can be maintained through times of increased pressure, including winter.

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Predicting length of stay for acute medical admissions using the ALICE score: a simple bedside tool

Research Audit and Clinical Practice, Volume 16, Issue 2, Pages 49 – 100 (2017)

Background: Early identification of patients likely to have a short admission permits best use of limited resources to facilitate rapid discharge where possible. The ALICE score is a simple bedside tool developed in one hospital as a decision aid. This study sought to confirm its widespread applicability.

Method: Retrospective review of 250 consecutive admissions at five acute hospitals. Clinical records were reviewed for a total of 1003 patients. ALICE score was calculated for each patient and compared to LoS data.

Results: There was a statistically significant positive correlation between rising ALICE scores and increasing length of stay irrespective of final diagnoses.

Conclusion: The ALICE score provides a simple bedside tool to predict length of stay.

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General medical follow-up clinics – does the traditional model need to be updated for new traditional model need to be updated for new acute physicians?

Original Articles, Volume 9, Issue 3, Pages 97 - 148 (2010)

Abstract

The follow up arrangements were reviewed for 212 patients discharged from our Medical Admissions Unit (MAU) prior to the appointment of an acute medical consultant. 19 patients (9%) were referred to speciality clinics, with only 1 patient being followed-up in a ‘general’ medical clinic; the patient’s GP was requested to follow up the majority of the outstanding results. Based on these results there appears little need or acute medical consultants to undertake ‘traditional’ outpatient follow-up clinics. Acute medical clinics may have other roles in enabling admission avoidance and reducing length of hospital stay.

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