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CC BY 4.0 · Avicenna J Med
DOI: 10.1055/s-0044-1788996
Original Article

The First Observational Study of Acute Medical Unit in Qatar

Abdel-Naser Elzouki
1   Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
2   Department of Medicine, College of Medicine, Qatar University, Doha, Qatar
3   Department of Medicine, Wiell Cornell Medical College-Qatar, Doha, Qatar
,
Phool Iqbal
1   Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
,
Mohammed Zahid
1   Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
2   Department of Medicine, College of Medicine, Qatar University, Doha, Qatar
3   Department of Medicine, Wiell Cornell Medical College-Qatar, Doha, Qatar
,
Ijaz Kamal
1   Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
3   Department of Medicine, Wiell Cornell Medical College-Qatar, Doha, Qatar
,
Anand Kartha 
1   Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
3   Department of Medicine, Wiell Cornell Medical College-Qatar, Doha, Qatar
,
Mustafa Al-Tekreti
1   Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
,
Dabia Al-Muhanadi
1   Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
3   Department of Medicine, Wiell Cornell Medical College-Qatar, Doha, Qatar
,
Ahmed Al-Mohamed
1   Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
3   Department of Medicine, Wiell Cornell Medical College-Qatar, Doha, Qatar
› Institutsangaben Funding None.
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Abstract

Background Acute medical unit (AMU) is a dedicated facility to treat patients with acute medical conditions requiring a short hospital stay (< 72 hours) with the support of a multidisciplinary team led by a medical consultant. We aim to present a study of the AMU model of care from Qatar to provide insight into its effects on patient care and management.

Methods Retrospective data from AMU facility at Hamad General Hospital (HGH), Doha, Qatar, was collected from January 2019 to December 2020 from the electronic patient record. The data were analyzed for demographic characteristics of the patients, length of stay (LOS), readmission rate, and postdischarge follow-up. The effectiveness of the AMU system was studied closely from this data. An extensive literature search was also performed for comparative results analysis in other AMU facilities outside Qatar.

Results Total admissions under the AMU facility were 8,371 from january2019 to December 2020. The 28 days readmission rate was 10.25 and 9.9% in 2019 and 2020, respectively. The average LOS was approximately 3.2 days. Around 88.7% of the patients were discharged home, 7.8% were admitted to medical wards due to longer stays, and 0.5% left against medical advice. Most of the patients admitted under AMU were 18 to 60 years old. The top primary diagnoses of admissions were minor stroke, transient ischemic attack, chest infection, urinary tract infections, and gastrointestinal and liver diseases. The most common comorbidities were hypertension, diabetes, acute kidney injury, and chronic kidney disease. A total of 2,858 patients were booked for a follow-up visit in the postdischarge clinic on discharge from the AMU for the year 2019 and 2020. The analysis of these followed up patients showed 73% of patients were discharged from clinic after first visit while the readmission from clinic was on only 1% (28 patients for year 2019 and 2020).

Conclusion Attentive patient care under AMU with a designated multidisciplinary medical team led by an internal medicine consultant is the cornerstone for the success of the AMU unit. This unit has proven very helpful for the smooth disposition of patients from the emergency department with reduced LOS, readmission rate, and overall mortality.

Keywords

acute medical unit - acute medicine - emergency department - length of stay - postdischarge clinic - readmission


Publikationsverlauf

Artikel online veröffentlicht:
22. August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Bodnar B, Kane EM, Rupani H. et al. Bed downtime: the novel use of a quality metric allows inpatient providers to improve patient flow from the emergency department. Emerg Med J 2022; 39 (03) 224-229
    CrossrefPubMedGoogle Scholar
  • 2 Lee S-Y, Chinnam RB, Dalkiran E, Krupp S, Nauss M. Prediction of emergency department patient disposition decision for proactive resource allocation for admission. Health Care Manage Sci 2020; 23 (03) 339-359
    CrossrefPubMedGoogle Scholar
  • 3 Laam LA, Wary AA, Strony RS, Fitzpatrick MH, Kraus CK. Quantifying the impact of patient boarding on emergency department length of stay: all admitted patients are negatively affected by boarding. J Am Coll Emerg Physicians Open 2021; 2 (02) e12401
    CrossrefPubMedGoogle Scholar
  • 4 Reid LEM, Pretsch U, Jones MC, Lone NI, Weir CJ, Morrison Z. The acute medical unit model: a characterisation based upon the National Health Service in Scotland. PLoS One 2018; 13 (10) e0204010
    CrossrefPubMedGoogle Scholar
  • 5 Health Care Index by Country. 2021 [Internet]. Accessed July 30, 2024 at: https://www.numbeo.com/health-care/rankings_by_country.jsp
    PubMedGoogle Scholar
  • 6 Alyamani NA, Hopf Y, Williams DJ. Prescription quality in an acute medical ward. Pharmacoepidemiol Drug Saf 2009; 18 (12) 1158-1165
    CrossrefPubMedGoogle Scholar
  • 7 Goh W-P, Han HF, Segara UC, Baird G, Lateef A. Acute medical unit: experience from a tertiary healthcare institution in Singapore. Singapore Med J 2018; 59 (10) 510-513
    CrossrefPubMedGoogle Scholar
  • 8 Moloney ED, Bennett K, Silke B. Effect of an acute medical admission unit on key quality indicators assessed by funnel plots. Postgrad Med J 2007; 83 (984) 659-663
    CrossrefPubMedGoogle Scholar
  • 9 Rooney T, Moloney ED, Bennett K, O'Riordan D, Silke B. Impact of an acute medical admission unit on hospital mortality: a 5-year prospective study. QJM 2008; 101 (06) 457-465
    CrossrefPubMedGoogle Scholar
  • 10 Bokhorst JAC, van der Vaart T. Acute medical unit design – the impact of rearranged patient flows. Socioecon Plann Sci 2018; 62: 75-83
    CrossrefGoogle Scholar
  • 11 Coary R, Byrne D, O'Riordan D, Conway R, Cournane S, Silke B. Does admission via an acute medical unit influence hospital mortality? 12 years' experience in a large Dublin hospital. Acute Med 2014; 13 (04) 152-158
    CrossrefPubMedGoogle Scholar
  • 12 Reid LEM, Crookshanks AJF, Jones MC, Morrison ZJ, Lone NI, Weir CJ. How is it best to deliver care in acute medical units? A systematic review. QJM 2018; 111 (08) 515-523
    CrossrefPubMedGoogle Scholar
  • 13 Reid LEM, Dinesen LC, Jones MC, Morrison ZJ, Weir CJ, Lone NI. The effectiveness and variation of acute medical units: a systematic review. Int J Qual Health Care 2016; 28 (04) 433-446
    CrossrefPubMedGoogle Scholar
  • 14 van Galen LS, Lammers EMJ, Schoonmade LJ, Alam N, Kramer MHH, Nanayakkara PWB. Acute medical units: the way to go? A literature review. Eur J Intern Med 2017; 39: 24-31
    CrossrefPubMedGoogle Scholar
  • 15 Scott I, Vaughan L, Bell D. Effectiveness of acute medical units in hospitals: a systematic review. Int J Qual Health Care 2009; 21 (06) 397-407
    CrossrefPubMedGoogle Scholar
  • 16 Conway R, O'Riordan D, Silke B. Long-term outcome of an AMAU–a decade's experience. QJM 2014; 107 (01) 43-49
    CrossrefPubMedGoogle Scholar
  • 17 Lambert L. The consultant physician and the acute medical assessment unit. Clin Med (Lond) 2006; 6 (03) 234-235
    CrossrefPubMedGoogle Scholar
  • 18 White AL, Armstrong PA, Thakore S. Impact of senior clinical review on patient disposition from the emergency department. Emerg Med J 2010; 27 (04) 262-265 , 296
    CrossrefPubMedGoogle Scholar
  • 19 McNeill G, Brahmbhatt DH, Prevost AT, Trepte NJB. What is the effect of a consultant presence in an acute medical unit?. Clin Med (Lond) 2009; 3: 214-218
    CrossrefPubMedGoogle Scholar
  • 20 Conway R, O'Riordan D, Silke B. Long-term outcome of an AMAU–a decade's experience. QJM 2014; 107 (01) 43-49
    CrossrefPubMedGoogle Scholar
  • 21 Suthers B, Pickles R, Boyle M, Nair K, Cook J, Attia J. The effect of context on performance of an acute medical unit: experience from an Australian tertiary hospital. Aust Health Rev 2012; 36 (03) 320-324
    CrossrefPubMedGoogle Scholar
  • 22 Beckett DJ, Thomson E, Reid LE, Lloyd RC. Variation in acute medicine units: measuring it, understanding it, and reducing it. Acute Med 2016; 15 (03) 111-118
    CrossrefPubMedGoogle Scholar
  • 23 Micallef A, Buttigieg SC, Tomaselli G, Garg L. Defining delayed discharges of inpatients and their impact in acute hospital care: a scoping review. Int J Health Policy Manag 2022; 11 (02) 103-111
    PubMedGoogle Scholar
  • 24 Cadel L, Guilcher SJT, Kokorelias KM. et al. Initiatives for improving delayed discharge from a hospital setting: a scoping review. BMJ Open 2021; 11 (02) e044291
    CrossrefPubMedGoogle Scholar
  • 25 Jamdar RP, Beckett DJ, Adamson K, Stewart C. Impact of a new daily rapid access medical clinic in a Scottish district general hospital. Emerg Med J 2010; 27 (07) 530-532
    CrossrefPubMedGoogle Scholar