Clinical quality indicators for acute medical units
SAM has published the following clinical quality indicators for acute medical units:
- All patients admitted to the AMU should have an early warning score measured upon arrival on the AMU.
- All patients should be seen by a competent clinical decision maker within 4 hours of arrival on the AMU who will perform a full assessment and instigate an appropriate management plan.
- All patients should be reviewed by the admitting consultant physician or an appropriate specialty consultant physician [senior clinical decision maker] within 14 hours of arrival on the AMU (8 hours for patients arriving between 8am and 6pm).
All acute medical units should collect the following data:
- hospital mortality rates for all patients admitted via the AMU
- proportion of admitted patients who are discharged directly from the AMU
- proportion of patients discharged from the AMU who are readmitted to hospital within 7 days of discharge.
Society for Acute Medicine Benchmark Audit (SAMBA)
SAM’s quality indicators form part of a national annual audit, held over one day in June. During the 24 hours of the audit, all patients presenting to AIM are audited against the quality indicators. Other information is also collected, for example access to diagnostic tests and the frailty of patients. The audit allows units to benchmark their performance against other units and provides a snapshot of AIM in the UK.
Quality care standards
There a number of published quality care standards that provide a blueprint for acute medical services and AMUs. Some recommendations are viewed by service providers as aspirational; however the recommendations clearly define excellence in acute medical care.
Guidelines for sick patients
The RCP’s National Early Warning Score (NEWS) advocates a system to standardise the assessment and response of patients with acute illness.
The NICE guideline Acutely ill patients in hospital: recognising and responding to deterioration is also pertinent to the AMU.
Standards expected of clinical decision makers
The RCP’s Acute medical care: the right person, in the right setting – first time defines the standards expected of clinical decision makers as follows:
A competent clinical decision maker: ‘Has undertaken a period of specific training to use the various tools of clinical assessment combined with appropriate use and interpretation of investigation. This facilitates the development of a rational differential diagnosis followed by prompt, safe and effective treatment of the patient. These skills are subject to assessment by more senior members of the team who have already developed these specific competencies.’
A senior clinical decision maker: ‘Is a medical practitioner who has the competencies and experience to make a prompt clinical diagnosis and decide the need for specific investigations and treatment, the mode of treatment, and the most appropriate setting for that treatment and ongoing care.’
In practice, a competent decision maker is a doctor in training or an appropriately trained advanced nurse practitioner, and a senior clinical decision maker is a consultant physician or a senior specialist registrar.
