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New toolkit to deliver increased consultant care to acutely ill medical patients

The fourth in the series of acute care toolkits from the RCP has been produced in collaboration with the Society of Acute Medicine (SAM). The toolkit focuses on changes to the organisation of care, working practices and medical rotas to ensure a consultant physician is available to review acutely ill patients on the acute medical unit (AMU) 12 hours a day, 7 days a week.

Acute medical illness is a 7-day problem – patients are 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 RCP and SAM recommending that a consultant physician – dedicated to care of acutely ill patients – should be available on site to review patients for at least 12 hours a day, every day*.

Dr Mark Temple, RCP acute care fellow, outlines how the toolkit can help deliver 12-hour consultant presence, 7 days a week:

The 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 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?

Key recommendations

  • During the period of consultant presence on AMUs, all newly admitted patients should be seen within a maximum of 6–8 hours, with the provision for immediate consultant review for severely ill patients.
  • All patients in the AMU should be reviewed twice each day by the AMU consultant or the appropriate specialty team; most units will require more than one AMU consultant working each day to meet this requirement.
  • Consultant duties on the AMU should start no later than 8am and the consultant shift should usually be for between 8 and 12 hours.
  • When undertaking clinical duties on the AMU, the consultant should be free from any other specialty, ward or management commitments.
  • Individual consultants’ duties on the AMU should be for 2 or more consecutive days; any variation must be specifically designed to optimise the continuity of care provided to patients on the AMU.
  • 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.

Dr Mark Temple, RCP acute care fellow, said:

Consultant review of acutely ill patients 12 hours a day, 7 days a week is key to the delivery of care that is of the highest quality on the acute medical unit (AMU). AMUs together with emergency departments are the busiest clinical areas in the hospital.

This toolkit provides important new guidance on working practices during the consultant shift on the AMU and the number of patients a single consultant can be expected to review during this shift. Hospitals struggling to cope with increasing emergency admissions, can use the toolkit to reconfigure acute medical services and ensure that daily consultant review is integral to the provision of high-quality care to patients with acute illness.

Dr Chris Roseveare, president of the Society of Acute Medicine, said:

The presence of a consultant on the acute medical unit is essential to ensure high-quality, safe, effective patient care; this toolkit is the first document which provides practical solutions to enable this to be achieved, for a minimum of 12 hours per day, 7 days per week.

Clinicians and managers now have the opportunity to calculate the workforce which they will require to deliver this, based on factors such as the size and configuration of the AMU, as well as the numbers of patients admitted on a daily basis. This is a landmark in acute medical care and represents a major step forward for the treatment of patients admitted to hospital in an emergency.

Notes to editors

  • For further information, please contact Linda Cuthbertson, head of PR, on +44 (0)203 075 1254 / 0774 877 7919, or email Linda.Cuthbertson@rcplondon.ac.uk
  • The toolkit and appendices are now available to download.
  • *In November 2010, in response to the mounting evidence of poor care delivered to patients admitted to hospital in the evenings and at weekends, the RCP recommended that any hospital admitting acutely ill patients should have a consultant physician on site for at least 12 hours per day, 7 days a week, who should have no other duties scheduled during this time. All medical wards should have a daily visit from a consultant; in most hospitals this will involve more than one physician.
  • * The SAM states that consultant-led care must be consistently delivered in all acute medical units (AMUs) in the UK, 7 days per week, and that a consultant should be available on the AMU for 12 hours per day, including Saturday and Sunday.