title: Impact of a new daily rapid access medical clinic in a Scottish district general hospital.
abstract: BACKGROUND
  Medical admissions to hospital in the UK are rising by approximately 10% per year. A Medical Assessment Unit (MAU) was opened to help deal with the rising influx of patients. The objectives of this study were to determine if a daily rapid access medical clinic could provide a safe alternative to hospital admission and aid safe discharge for medical patients.
  
  
  METHODS
  The rapid access clinic was embedded within the MAU, utilising existing resources. Patients were allocated and reviewed by a senior acute medicine specialist registrar (SpR). Data were collected from January to September 2008.
  
  
  RESULTS
  74 patients seen in the clinic were analysed. 93% of these were managed in an ambulatory fashion, avoiding admission and saving a potential 280 bed days. The same day discharge rate of all patients seen and assessed in the MAU was increased from 17% to 26% (p<0.001), following institution of the clinic. The readmission rate fell from 8% to 4% (p=0.12).
  
  
  CONCLUSIONS
  A daily rapid access medical clinic embedded within a MAU was piloted and allowed the safe management of a variety of medical complaints in an ambulatory fashion. It enabled an increase in the discharge rate of patients referred for admission by general practitioners. This seemed to be more robust than as evidenced previously by a trend towards lower readmission rates. These results were dependent on the presence of a senior clinical decision maker to facilitate safe discharges.
authors.affiliation: Department of Acute Medicine, St John's Hospital, Howden Road West, Livingston, West Lothian EH54 6PP, UK. Jamdar@btinternet.com
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Jamdar
authors.forename: D J
authors.initials: DJ
authors.lastname: Beckett
authors.forename: Karen
authors.initials: K
authors.lastname: Adamson
authors.forename: Casey
authors.initials: C
authors.lastname: Stewart
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D058005:General Practitioners / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D012606:Scotland; D013997:Time Factors