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

PLoS One. 2013 Apr 17;8(4):e61476. doi: 10.1371/journal.pone.0061476. Print 2013.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Consultants / statistics & numerical data*
  • Emergency Service, Hospital / statistics & numerical data
  • England
  • Hospitals / statistics & numerical data*
  • Humans
  • Multivariate Analysis
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Patient Admission / statistics & numerical data*
  • Regression Analysis
  • Treatment Outcome

Grant support

The authors have no support or funding to report.