Impact of consultant specialty on discharge decisions in patients admitted as medical emergencies to hospitals in the United Kingdom

• Published in: QJM : An International Journal of Medicine Vol. 110; no. 2; pp. 97 - 102
• Main Authors: Subbe, C P, Jeune, Ivan Le, Ward, D, Pradhan, S, Masterton-Smith, C
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.02.2017
• Subjects: Adult; Aged; Aged, 80 and over; Ambulatory Care - statistics & numerical data; Clinical Decision-Making; Consultants; Emergencies; Emergency Service, Hospital - standards; Emergency Service, Hospital - statistics & numerical data; Female; Health Services Research - methods; Hospitalization - statistics & numerical data; Humans; Male; Medical Audit; Medical Staff, Hospital - statistics & numerical data; Medicine - statistics & numerical data; Middle Aged; Original Papers; Patient Care Team; Patient Discharge - statistics & numerical data; Prospective Studies; Quality Indicators, Health Care; United Kingdom
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcw173

The Society for Acute Medicine's Benchmarking Audit (SAMBA) annually examines Clinical Quality Indicators (CQIs) of the care of patients admitted to UK hospitals as medical emergencies. The aim of this study is to review the impact of consultant specialty on discharge decisions in the SAMBA data-set. Prospective audit of patients admitted to acute medical units (AMUs) on 25 June 2015 to participating hospitals throughout the UK with subgroup analysis. Eighty-three units submitted patient data from 3138 patients.Nearly 1845 (58%, IQR for units 50-69%) of patients were referrals from Emergency Medicine, 1072 (32%, IQR for units 24-44%) were referrals from Primary Care. The mean age was 65 (SD 20). One hundred and forty-one (4.5%) patients were admitted from care homes and 951 (30%) of patients were at least 'mildly frail' and 407 (13%) had signs of physiological instability. The median and the mean time to being seen by a doctor were 1 h 20 min and 2 h 3 min, respectively. The median and the mean time to being seen by senior specialist were 3 h 55 min and 5 h 56 min, respectively. By 72 h, 29 (1%) patients had died in the AMU, 73 were admitted to critical care units, 1297 (41%) had been discharged to their own home and 60 to nursing or residential homes. For every 100 patients seen specialists in acute medicine discharged 12 more patients than specialists from other disciplines of medicine ( P  < 0.001). The difference remained significant after adjustment for case mix. Specialist in acute care might facilitate discharge in a higher proportion of patients.