Abstract
Purpose
To evaluate the evidence for the effectiveness of acute medical units (AMUs) compared with other models of care and compare the components of AMU models.
Data sources
Six electronic databases and grey literature sources searched between 1990 and 2014.
Study selection
Studies reporting on AMUs as an intervention for unplanned medical presentations to hospital with the inclusion of all outcome measures/study designs/comparators.
Data extraction
Data on study characteristics/outcomes/AMU components were extracted by one author and confirmed by a second.
Data synthesis
Seventeen studies of 12 AMUs across five countries were included. The AMU model was associated with a reduction in-hospital length of stay (LOS) in all analyses ranging from 0.3 to 2.6 days; and a reduction in mortality in 12 of the 14 analyses with the change ranging from a 0.1% increase to a 8.8% reduction. Evidence relating to readmissions and patient/staff satisfaction was less conclusive. There was variation in the following components of AMUs: admission criteria, entry sources, functions and consultant work patterns.
Conclusion
This review provides evidence that AMUs are associated with reductions in-hospital LOS and, less convincingly, mortality compared with other models of care when implemented in European and Australasian settings. Reported estimates may be affected by residual confounding. This review reports heterogeneity in components of the AMU model. Further work to identify what constitutes the key components of an AMU is needed to improve the quality and effectiveness of acute medical care. This is of particular importance given the escalating demand on acute services.
To evaluate the evidence for the effectiveness of acute medical units (AMUs) compared with other models of care and compare the components of AMU models.
Data sources
Six electronic databases and grey literature sources searched between 1990 and 2014.
Study selection
Studies reporting on AMUs as an intervention for unplanned medical presentations to hospital with the inclusion of all outcome measures/study designs/comparators.
Data extraction
Data on study characteristics/outcomes/AMU components were extracted by one author and confirmed by a second.
Data synthesis
Seventeen studies of 12 AMUs across five countries were included. The AMU model was associated with a reduction in-hospital length of stay (LOS) in all analyses ranging from 0.3 to 2.6 days; and a reduction in mortality in 12 of the 14 analyses with the change ranging from a 0.1% increase to a 8.8% reduction. Evidence relating to readmissions and patient/staff satisfaction was less conclusive. There was variation in the following components of AMUs: admission criteria, entry sources, functions and consultant work patterns.
Conclusion
This review provides evidence that AMUs are associated with reductions in-hospital LOS and, less convincingly, mortality compared with other models of care when implemented in European and Australasian settings. Reported estimates may be affected by residual confounding. This review reports heterogeneity in components of the AMU model. Further work to identify what constitutes the key components of an AMU is needed to improve the quality and effectiveness of acute medical care. This is of particular importance given the escalating demand on acute services.
| Original language | English |
|---|---|
| Pages (from-to) | 433-446 |
| Number of pages | 14 |
| Journal | International Journal for Quality in Health Care |
| Volume | 28 |
| Issue number | 4 |
| Early online date | 16 Jun 2016 |
| DOIs | |
| Publication status | Published - 12 Sept 2016 |
Bibliographical note
This work was supported by the Royal College of Physicians of Edinburgh and the Health and Social Care Directorates at the Scottish Government. C.J.W. was supported in this work by NHS Lothian via the Edinburgh Health Services Research Unit.Keywords
- Acute medical unit
- Systematic review
- Variation
