Outcomes of establishing an acute assessment unit in the general medical service of a tertiary teaching hospital.
OBJECTIVE
To evaluate the impact of an acute assessment unit (AAU) on length of hospital stay (LOS), emergency department (ED) waiting times, direct discharge rate, unplanned readmission rate and all-cause hospital mortality of general medical patients.


METHODS
Retrospective comparison of data for general medical patients admitted to a tertiary teaching hospital in Adelaide, South Australia, before and after the establishment of an AAU (reference years, 2003 [before] and 2006 [after]).


METHODS
Mean LOS, ED waiting times and all-cause hospital mortality during calendar years 2003 (pre-establishment) and 2006 (post-establishment).


RESULTS
Following the establishment of an AAU, the mean LOS shortened (from 6.8 days in 2003 to 5.7 days in 2006; P < 0.001) despite a 50.5% increase in the number of admissions (from 2652 to 3992). The number of admitted patients waiting in the ED more than 8 hours for a hospital bed decreased (from 28.7% to 17.9%; P < 0.001), as did the number waiting more than 12 hours (from 20.2% to 10.4%; P < 0.001). The rates of unplanned readmission within 7 and 28 days did not change. The all-cause hospital mortality for general medical admissions was 4.6% in 2003 v 3.7% in 2006 (P = 0.056).


CONCLUSIONS
The establishment of an AAU within the general medical service coincided with decreases in both LOS and ED waiting times, despite a 50% increase in admissions. This structural reform in the process of acute medical care may have contributed to the improvement in these key health care performance indices without compromising the quality of patient care.
Li
Jordan Y Z
JY
Department of General Medicine, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia. jordan.li@health.sa.gov.au
Yong
Tuck Y
TY
Bennett
Denise M
DM
O'Brien
Lauri T
LT
Roberts
Susan
S
Hakendorf
Paul
P
Ben-Tovim
David I
DI
Phillips
Paddy A
PA
Thompson
Campbell H
CH
D000368:Aged; D001071:Appointments and Schedules; D004636:Emergency Service, Hospital / Q000639:trends; D005260:Female; D006757:Hospital Units; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010343:Patient Admission; D010351:Patient Discharge; D012189:Retrospective Studies; D013021:South Australia