title: Acute medical units: The way to go? A literature review.
abstract: BACKGROUND
  Acute healthcare chains in the Netherlands are increasingly under pressure because of rising emergency department (ED) admissions, relative bed shortages and government policy changes. In order to improve acute patient flow and quality of care through hospitals, an acute medical unit (AMU) might be a solution, as demonstrated in the UK. However, limited information is available concerning AMUs in the Netherlands. Therefore, the aims of this study were to METHODS: A systematic literature search was performed searching 3 electronic databases: PubMed, Cochrane and EMBASE. All 106 hospitals in the Netherlands were contacted, inquiring about the status of an ED, the AMU or future plans to start one.
  
  
  RESULTS
  The literature search resulted in 31 studies that met inclusion criteria. In general, these studies reported significant benefits on number of admissions, hospital length of stay (LOS), mortality, other wards and readmissions. Among the Dutch hospitals with an ED, 33 out of 93 implemented an AMU or similar ward, these are however organized heterogeneously. Following current trends, more AMUs are expected to be realized in the future.
  
  
  CONCLUSIONS
  In order to improve the current strain on the Dutch acute healthcare system, an AMU could potentially provide benefits. However, uniform guideline is warranted to optimize and compare quality of care throughout the Netherlands.
authors.affiliation: VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands.
authors.forename: L S
authors.initials: LS
authors.lastname: van Galen
authors.affiliation: VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands.
authors.forename: E M J
authors.initials: EM
authors.lastname: Lammers
authors.affiliation: VU University Medical Centre, Medical Library, VU University, Amsterdam, The Netherlands.
authors.forename: L J
authors.initials: LJ
authors.lastname: Schoonmade
authors.affiliation: VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Alam
authors.affiliation: VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands.
authors.forename: M H H
authors.initials: MH
authors.lastname: Kramer
authors.affiliation: VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands. Electronic address: p.nanayakkara@vumc.nl.
authors.forename: P W B
authors.initials: PW
authors.lastname: Nanayakkara
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D004636:Emergency Service, Hospital / Q000639:trends*; D006284:Health Plan Implementation; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay; D009426:Netherlands; D010343:Patient Admission / Q000706:statistics & numerical data*
keywords: Acute medical unit; Healthcare quality; Implementation guidelines