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RCP tackles excess weekend mortality

College guides hospitals on how to provide full 7-day acute illness cover

Louise Prime

Thursday, 11 October 2012

The Royal College of Physicians is helping hospitals to combat the well-known problem of higher mortality and worse outcomes for patients admitted as an emergency at the weekends, compared with weekdays. Its ‘landmark’ toolkit, published today, guides senior clinicians and managers through how to provide effective 7-days-a-week consultant care for acutely ill patients.

The RCP worked with the Society of Acute Medicine (SAM) to develop its fourth acute care toolkit, Delivering a 12-hour, 7-day consultant presence on the acute medical unit. They say a consultant physician dedicated to the care of acutely ill patients should be consistently available on site to review patients for a minimum of 12 hours a day, 7 days a week. They also recommend that:

  • During the period of consultant presence on acute medical units (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 8-12 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 at least two 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.

The toolkit guides senior hospital clinicians and managers through how to organise acute medical services to enable consistently high-quality care of acutely ill patients to be achieved. It enables them to work out the number of consultants needed to provide a daily 12-hour presence on the acute medical unit; how many patients a consultant should be expected to review during their AMU shift; how long that shift should be; and how to organise consultant working and support services to provide high-quality patient care every day of the week.

SAM president Dr Chris Roseveare 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.”

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