Consultant Input in Acute Medical Admissions and Patient Outcomes in Hospitals in England: A Multivariate Analysis
Open Access
- 17 April 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (4), e61476
- https://doi.org/10.1371/journal.pone.0061476
Abstract
Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.This publication has 12 references indexed in Scilit:
- The Association Between Hospital Volume and Processes, Outcomes, and Costs of Care for Congestive Heart FailureAnnals of Internal Medicine, 2011
- Hospital Volume and 30-Day Mortality for Three Common Medical ConditionsThe New England Journal of Medicine, 2010
- Effectiveness of acute medical units in hospitals: a systematic reviewInternational Journal for Quality in Health Care, 2009
- Impact of specialist care on clinical outcomes for medical emergenciesClinical Medicine, 2006
- The impact of weekends on outcome for emergency patientsClinical Medicine, 2005
- Effects of weekend admission and hospital teaching status on in-hospital mortalityThe American Journal of Medicine, 2004
- A confidential study of deaths after emergency medical admission: issues relating to quality of careClinical Medicine, 2003
- Mortality among Patients Admitted to Hospitals on Weekends as Compared with WeekdaysThe New England Journal of Medicine, 2001
- Confidential inquiry into quality of care before admission to intensive careBMJ, 1998
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987