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More consultants improve outcomes

Survey shows many hospitals still using outmoded patterns of care

Mark Gould

Monday, 02 April 2012

Patients have better outcomes and are less likely to be readmitted to hospital if they are cared for on wards that are staffed by dedicated consultant physicians trained in acute medical care.

The Royal College of Physicians has surveyed over 100 hospitals in England and claims to have shown for the first time that patients fare better if they have access to a consultant physician who is on call for more than one day at a time.

They also found outcomes improve if these doctors:

  • have no other routine duties during that time
  • do two or more ward rounds per day in the acute medical unit (AMU)
  • are present in the (AMU) for more than 4 hours for 7 days.

The RCP will now recommend this system of cover above all others. This new research fully supports the RCP’s recent call for consultant physicians to be on site for 12 hours per day, seven days a week.

The survey matched various systems of consultant cover against patient outcome data from hospital episode statistics, to see if there was an advantage to patient care from any of the different systems. It found: 

  • Hospitals in which admitting consultants have no other fixed clinical commitments while on acute take had a lower adjusted case fatality rate
  • Hospitals in which the admitting consultants work blocks of more than one day had lower excess weekend mortality
  • Hospitals in which there were two or more acute medical unit (AMU) ward rounds per day reviewing all patients on the unit had a lower adjusted case fatality rate for patients with a hospital length of stay of more than seven days
  • Hospitals where the admitting consultant was present for more than four hours for seven days per week had a lower 28 day readmission rate
  • Hospitals in which there were two or more AMU ward rounds per day on weekdays and admitting consultants work blocks of more than one day had a lower adjusted case fatality rate (i.e. less excess mortality).

While some hospitals are already using this system the survey also showed that many hospitals were operating other patterns of care with poorer outcomes, in particular:

  • Most trusts are still using ‘consultant of the day’ instead of the recommended ‘consultant of several days’
  • In almost half of the hospitals, the first consultant on call undertakes other routine clinical duties while managing the acute take as opposed to being dedicated to the acute take
  • In many hospitals, acute medical patients are only reviewed once daily by a consultant, not twice daily.

Dr Kevin Stewart, clinical director of the RCP’s clinical effectiveness and evaluation unit said: “The profile of acute medical patients has changed dramatically over the past 20 years, yet in some hospitals changes in consultant working patterns have been much slower. Traditional rotas are neither safe for patients, nor good for clinicians. Now, patients are older, sicker and have more complex conditions, and they require dedicated consultants to be available on site 7 days per week for at least 12 hours a day.”

Dr Simon Conroy, from the British Geriatrics Society, welcomed the findings which he said “emphasises the importance of getting frail older people seen at the earliest possible opportunity in their admission to maximise outcomes”.

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