title: Does admission via an acute medical unit influence hospital mortality? 12 years' experience in a large Dublin hospital.
abstract: BACKGROUND
  Following an emergency medical admission, patients may be admitted an acute medical assessment unit (AMAU) or directly into a ward. An AMAU provides a structured environment for their initial assessment and treatment.
  
  
  METHODS
  All emergency admissions (66,933 episodes in 36,271 patients) to an Irish hospital over an 12-year period (2002-2013) were studied with 30-day in-hospital mortality as the outcome measure. Univariate Odds Ratios, by initial patient allocation, and the fully adjusted Odds Ratios were calculated, using a validated logistic regression model.
  
  
  RESULTS
  Patients, by design, were intended to be admitted initially to the AMAU (<= 5 day stay). Capacity constraints dictated that only 39.8% of patients were so admitted; the remainder bypassed the AMAU to a ward (60.2%). All patients remained under the care of the admitting consultant/team. We computed the risk profile for each group, using a multiple variable validated model of 30-day in-hospital mortality; the model indicated the same risk profile between these groups. The univariate OR of an in-hospital death by day 30 for a patient initially allocated to the AMAU, compared with an initial ward allocation was 0.76 (95% CI: 0.71, 0.82- p<0.001). The fully adjusted risk for patients was 0.67 (95% CI: 0.62, 0.73- p<0.001).
  
  
  CONCLUSIONS
  Patients, with equivalent mortality risk, allocated initially to AMAU or a more traditional ward, appeared to have substantially different outcomes.
authors.forename: R
authors.initials: R
authors.lastname: Coary
authors.forename: D
authors.initials: D
authors.lastname: Byrne
authors.forename: D
authors.initials: D
authors.lastname: O'Riordan
authors.forename: R
authors.initials: R
authors.lastname: Conway
authors.forename: S
authors.initials: S
authors.lastname: Cournane
authors.affiliation: Department of Internal Medicine St James's Hospital, Dublin 8, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Silke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies / Q000145:classification / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D017050:Episode of Care; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D014218:Triage / Q000379:methods