title: Delays and interruptions in the acute medical unit clerking process: an observational study.
abstract: OBJECTIVE
  It is recommended that patients are seen within 4 h of arrival in Acute Medical Units in English hospitals. This study explored the frequency and nature of interruptions and delays potentially affecting the duration of the Acute Medical Unit admission process and the quality of care provided.
  
  
  METHODS
  The admission process was directly observed for patients admitted to the Acute Medical Unit over four one-week periods, November 2009 to April 2011.
  
  
  METHODS
  UK teaching hospital Acute Medical Unit.
  
  
  METHODS
  Hospital staff n = 36.
  
  
  METHODS
  Patient waiting times, duration of clerking, number of interruptions and/or delays.
  
  
  RESULTS
  Thirty-five doctors and one nurse practitioner were observed admitting 71 medical patients, 48/71 (68%) patients were clerked within 4 h of arrival. A delay and/or interruption affected 49/71 (69%) patients. Sixty-six interruptions were observed in 36/71 (51%) of admissions, of these 19/36 (53%) were interrupted more than once. The grade of doctor had no bearing on the frequency of interruption; however, clerking took significantly longer when interrupted; overall doctors grade ST1 and above were quicker at clerking than foundation doctors. Delays affected 31/71 (44%) of admissions, 14/31 (45%) involved X-rays or ECGs; other causes of delays included problems with equipment and computers.
  
  
  CONCLUSIONS
  Interruptions and delays regularly occurred during the admission process in the study hospital which impacts adversely on patient experience and compliance with the recommended 4-h timeframe, further work is required to assess the impact on patient safety. Data obtained from this observational study were used to guide operational changes to improve the process.
authors.affiliation: Royal Liverpool University Hospital, Liverpool, L7 8XP, UK; School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK.
authors.forename: Avril J
authors.initials: AJ
authors.lastname: Basey
authors.affiliation: Royal Liverpool University Hospital, Liverpool, L7 8XP, UK.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Kennedy
authors.affiliation: School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Mackridge
authors.affiliation: Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Anson Building, Central Avenue, Chatham Maritime, Chatham, Kent, ME4 4TB, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Krska
keywords: Acute medical unit; admission; clerking; interruption; medical history taking; waiting time