Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

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 stud...

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Autores principales:	Derek Bell, Adrian Lambourne, Frances Percival, Anthony A Laverty, David K Ward
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/60fa1709eb4e4e86a8afba59b5cbccdd
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spelling	oai:doaj.org-article:60fa1709eb4e4e86a8afba59b5cbccdd2021-11-18T07:49:05ZConsultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.1932-620310.1371/journal.pone.0061476https://doaj.org/article/60fa1709eb4e4e86a8afba59b5cbccdd2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23613858/?tool=EBIhttps://doaj.org/toc/1932-6203Recent 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 (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An 'all inclusive' pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 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.Derek BellAdrian LambourneFrances PercivalAnthony A LavertyDavid K WardPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 4, p e61476 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Derek Bell Adrian Lambourne Frances Percival Anthony A Laverty David K Ward Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.
description	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 (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An 'all inclusive' pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 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.
format	article
author	Derek Bell Adrian Lambourne Frances Percival Anthony A Laverty David K Ward
author_facet	Derek Bell Adrian Lambourne Frances Percival Anthony A Laverty David K Ward
author_sort	Derek Bell
title	Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.
title_short	Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.
title_full	Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.
title_fullStr	Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.
title_full_unstemmed	Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.
title_sort	consultant input in acute medical admissions and patient outcomes in hospitals in england: a multivariate analysis.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/60fa1709eb4e4e86a8afba59b5cbccdd
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Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

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