title: The effect of context on performance of an acute medical unit: experience from an Australian tertiary hospital.
abstract: OBJECTIVE
  To ascertain the improvements in length of stay and discharge rates following the opening of an acute medical unit (AMU).
  
  
  METHODS
  Retrospective cohort study of all patients admitted under general medicine from June-November 2008. Main outcome measures were length of stay in hospital and in the emergency department (ED).
  
  
  RESULTS
  The length of time spent in the emergency department for those admitted to the AMU was significantly shorter than those admitted directly to a medical ward (6.83h v. 9.40h, P<0.0001). A trend towards shorter hospital length of stay continued after the AMU opened compared with the same period in the previous year (5.15 days (2.49, 11.57 CI) v. 5.66 days (2.76, 11.52 CI)). However, the number of ward transfers for a patient and the need to wait for a nursing home bed or public rehabilitation affected length of stay much more than the AMU.
  
  
  CONCLUSIONS
  An AMU was successful in decreasing ED length of stay and contributed to decreasing hospital length of stay. However, we suggest that local context is crucially important in tailoring an AMU to obtain maximal benefit, and that AMUs are not a 'one size fits all' solution.
authors.affiliation: Department of Medicine, John Hunter Hospital, Lookout Road, New Lambton, NSW 2305, Australia. belinda.suthers@hnehealth.nsw.gov.au
authors.forename: Belinda
authors.initials: B
authors.lastname: Suthers
authors.forename: Robert
authors.initials: R
authors.lastname: Pickles
authors.forename: Michael
authors.initials: M
authors.lastname: Boyle
authors.forename: Kichu
authors.initials: K
authors.lastname: Nair
authors.forename: Justyn
authors.initials: J
authors.lastname: Cook
authors.forename: John
authors.initials: J
authors.lastname: Attia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies