Skip navigation

How is it best to deliver care in acute medical units? A systematic review

How is it best to deliver care in acute medical units? A systematic review

Reid, L. E. M., Crookshanks, A. J. F., Jones, M. C., Morrison, Z. J., Lone, N. I. and Weir, C. J. (2017) How is it best to deliver care in acute medical units? A systematic review. QJM: An International Journal of Medicine, 111 (8). pp. 515-523. ISSN 1460-2725 (Print), 1460-2393 (Online) (doi:https://doi.org/10.1093/qjmed/hcx161)

[img]
Preview
PDF (Author Accepted Manuscript)
21318 MORRISON_How_is_it_Best_to_Deliver_Care_in_Acute_Medical_Units_2017.pdf - Accepted Version

Download (635kB) | Preview

Abstract

The majority of medical patients presenting to hospital in the UK are cared for in acute medical units (AMUs). Such units are also increasingly present internationally. Care delivery varies across units: this review aims to examine the evidence for how best to deliver AMU care.

Six electronic databases and grey literature were searched. Inclusion criteria comprised interventions applied to undifferentiated patients in AMU settings. All studies were quality assessed. A narrative approach was undertaken.

Nine studies, all conducted in the UK or Ireland, evaluated 1.3 million episodes, 3617 patients and 49 staff. There was single study evidence for beneficial effects of: enhanced pharmacy care, a dedicated occupational therapy service, an all-inclusive consultant work pattern, a rapid-access medical clinic and formalized handovers. Two studies found increased consultant presence was associated with reduced mortality; one of these studies found an association with a reduction in 28-day readmissions; and the other found an association with an increased proportion of patients discharged on the day they were admitted. Three studies provide evidence of the beneficial effects of multiple interventions developed from local service reviews.

Overall, the quality of the evidence was limited. This review has identified operationally relevant evidence that increased consultant presence is associated with improved outcomes of care; has highlighted the potential to improve outcomes locally through service reviews; and has demonstrated an important knowledge gap of how best to deliver AMU care. These findings have importance given the challenges acute services currently face.

Item Type: Article
Uncontrolled Keywords: consultants, delivery of health care, ireland, patient readmission, pharmacies, mortality, occupational therapy, pharmacy (field), transition of care, narrative discourse
Subjects: R Medicine > RS Pharmacy and materia medica
Faculty / Department / Research Group: Faculty of Business
Faculty of Business > Department of Human Resources & Organisational Behaviour
Last Modified: 30 Aug 2018 15:35
Selected for GREAT 2016: None
Selected for GREAT 2017: None
Selected for GREAT 2018: None
Selected for GREAT 2019: None
URI: http://gala.gre.ac.uk/id/eprint/21318

Actions (login required)

View Item View Item

Downloads

Downloads per month over past year

View more statistics