title: Acute medicine targets: when should the clock start and 7-day consultant impact?
abstract: BACKGROUND
  Early consultant review has been shown to improve outcomes in patients presenting to the Acute Medical Unit (AMU). The Society for Acute Medicine (SAM) clinical quality indicators use the time of arrival on the AMU for target rather than arrival in the Emergency Department (ED) although this is where most acute medical patients present.
  
  
  OBJECTIVE
  To determine the effect of a 7-day Consultant Acute Physician model on patient waiting times and assess the impact of starting the clock for medical patients at time of ED arrival.
  
  
  METHODS
  We performed an audit at a University Hospital AMU in the North West of England.
  
  
  METHODS
  Data were collected prospectively for 15 consecutive days in May-June 2013 for all patients presenting to the AMU at University Hospital of South Manchester and were repeated for the same time period in 2014 following the introduction of a new Consultant working model.
  
  
  RESULTS
  Four hundred and five patients were admitted to the AMU in the 2013 cohort compared to 456 in the 2014 cohort. There was a significant improvement in the median waiting time for Consultant review from AMU admission to 5 h 53 min from 8 h 15 min (P < 0.001). The compliance with the SAM quality indicator for Consultant review improved from 88.7 to 93.7% (P = 0.022).
  
  
  CONCLUSIONS
  A 7-day Acute Physician working model is improving performance with regards to patient waiting times. We suggest that starting the clock for acute medical patients in the ED is a better measure of performance than on arrival to the AMU.
authors.affiliation: From the Department of Acute Medicine, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
authors.forename: S
authors.initials: S
authors.lastname: Lang
authors.affiliation: From the Department of Acute Medicine, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK cooks199@hotmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Cooksley
authors.affiliation: From the Department of Acute Medicine, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
authors.forename: P
authors.initials: P
authors.lastname: Foden
authors.affiliation: From the Department of Acute Medicine, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
authors.forename: M
authors.initials: M
authors.lastname: Holland
mesh_terms: D000208:Acute Disease; D000368:Aged; D003253:Consultants; D004636:Emergency Service, Hospital / Q000458:organization & administration; D004739:England; D005260:Female; D006302:Health Services Research / Q000379:methods; D006757:Hospital Units / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D013997:Time Factors; D014850:Waiting Lists