Acute care toolkit 4: Delivering a 12-hour, 7-day consultant presence on the acute medical unit

Acute medical illness is a 7-day problem, with patients just as likely to develop an acute illness requiring an emergency admission on a Saturday or Sunday as on a weekday. Evidence that patients admitted at weekends have poorer outcomes than those admitted on weekdays, and that patient mortality is higher at weekends, led to the Royal College of Physicians and the Society of Acute Medicine (SAM) recommending that a consultant physician ‒ dedicated to the care of acutely ill patients ‒ should be available on site to review patients for at least 12 hours a day, every day.

Key recommendations

  1. When undertaking clinical duties on the AMU, the consultant should be free from any other specialty, ward or management commitments.
  2. Individual consultants’ duties on the AMU should be for two or more consecutive days; any variation must be specifically designed to optimise continuity of care on the AMU.
  3. Appropriate diagnostic and support services should be provided 7 days per week, to ensure that the full benefits of consultant delivered-care to patients are realised.
  4. During the period of consultant presence on AMU, all newly admitted patients should be seen within 6 to 8 hours, with the provision for immediate review as required according to illness severity.
  5. A newly admitted patient must be seen by a consultant within 14 hours after arrival on AMU.
  6. All patients in the AMU should be reviewed twice each day by the AMU consultant or appropriate specialty team.
  7. Consultant presence on the AMU should start no later than 8am.
  8. Duration of an individual consultant’s presence on the AMU should usually be between 8 and 12 hours.
  9. Extended evening working until 10pm should be considered, depending on local patterns of patient referral and arrival.
  10. Calculation of numbers of consultants required on the AMU should be based on anticipated number of patient contacts during the core hours of service.
  11. Greater numbers of consultants may be required in larger or high-volume units, or those managing patients with greater dependency.

This toolkit provides practical guidance to senior hospital managers and clinical staff on how to organise acute medical services to ensure that the 12-hour consultant presence delivers consistent high-quality care to acutely ill patients.

The guidance provides answers to key questions including:

  • How many consultants are required to provide a daily 12-hour presence on the acute medical unit (AMU)?
  • How many patients should a consultant be expected to review during their shift on the AMU and how long should this shift be?
  • How should consultant working and support services be organised in order to provide high-quality patient care every day of the week?