Impact of a general medicine consultant‐led ward round in the emergency department

• Published in: Internal medicine journal Vol. 54; no. 8; pp. 1344 - 1350
• Main Authors: Bajaj, Nupur, Goyal, Tushar, Teo, Ken, Yip, Gary
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.08.2024; Wiley Subscription Services, Inc
• Subjects: access to care; Adult; Aged; Aged, 80 and over; Consultants; Electronic medical records; emergency department; Emergency medical care; Emergency Service, Hospital; Female; General Practice - organization & administration; hospitalists; Hospitals, Public; Humans; internal medicine; length of stay; Length of Stay - statistics & numerical data; Male; Medicine; Middle Aged; Patient Readmission - statistics & numerical data; Patients; Surveys; Teaching Rounds; Victoria; Victoria; internal medicine; length of stay; hospitalists; access to care; emergency department
• ISSN: 1444-0903; 1445-5994; 1445-5994
• DOI: 10.1111/imj.16362

Background Patients requiring admission to the general medicine wards in a public hospital are usually assessed by a medical registrar. This study is based at a metropolitan public hospital in Melbourne where the majority of general medicine patients in the emergency department (ED) are not seen by a consultant physician until they are transferred to the ward. Aims To assess the impact of general medicine consultant‐led ward rounds (CWRs) in the ED on patient length of stay (LOS). Methods One‐month audit was conducted of all patients admitted to general medicine and awaiting transfer to ward from ED at a metropolitan public hospital in Melbourne. A general medicine CWR was then implemented in the ED, followed by another 1‐month audit, with the primary outcome being LOS and the secondary outcome being 30‐day readmission rate. Additionally, admitting medical registrars were invited to complete a survey before and after the implementation of CWRs to assess satisfaction rate. Results Data from electronic medical records were analysed for 162 patients (90 preimplementation group and 72 postimplementation group). The median LOS was 6 days in the preimplementation group and 4 days in the postimplementation group (P = 0.014). There was no significant difference in 30‐day readmission rates. Surveys showed admitting medical registrars reported a reduced level of stress and fewer barriers to seeking consultant input following implementation. Conclusions A CWR in the ED has led to decreased LOS for general medicine patients and improved satisfaction among junior medical staff.