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Three Part Question

In [adults, with specific conditions who were admitted to the Medical Admissions Unit (MAU) for less than 72 hours in 2011,] does [the decision making process on admission by doctors] have [an impact on admission avoidance to the MAU].

Clinical Scenario

Avoiding emergency hospital admissions is an important subject, and this audit aims to seek whether patients were triaged appropriately, according to established guidelines, for admission on the Medical Assessment Unit (MAU). The importance of doctors making a correct diagnosis will also be analysed, therefore seeing whether the decision making process by doctors have an impact on avoidable admissions.

Search Strategy

A retrospective, single center, audit was performed on a representative sample of 119 patients with specific discharged conditions. In addition a literature review of well established research papers will be done to look at the influence of the decision making process by doctors and its affect on admission avoidance.
Each case note was reviewed individually, with each condition having individual variables as different guidelines were used for each condition. In addition, clinical quality indicators for MAU were audited to see the performance of the department.

Search Outcome

10% of the admissions in this sample could have been avoided. 83.3% of the avoidable admissions did not follow the established guidelines. 58.3% of the patients who could have avoided admission had a different admissions diagnosis compared to the final diagnosis, with lack of a differential diagnosis at admissions being the main reason for this. 50% of the Modified Early Warning Score (MEWS) was not documented and 14% of patients did not have a full clinical assessment and management plan initiated within 4 hours of their arrival on MAU.

From the literature search the demand for more accurate documentation was highlighted as well as the requirement for interventions to reduce hospital admissions in the community and outpatients. By using appropriate tools and national guidelines, one can arrive at a correct diagnosis and differential diagnosis, which may lead to avoiding inappropriate hospital admissions.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Clinical Bottom Line

The demand for more accurate documentation was highlighted as well as the requirement for interventions to reduce hospital admissions in the community and outpatients. By using appropriate tools and national guidelines, one can arrive at a correct diagnosis and differential diagnosis, which may lead to avoiding inappropriate hospital admissions.

References

1. Bhandari
 S. A
 single‐centre
 audit
 of
 junior
 doctors'
 diagnostic
 activity
 in
 medical
 admissions J R Coll Physicians Edinb
2. Rossdale
 M,
 Kemple
 T,
 Payne
 S,
 Calnan
 M,
 Greenwood
 R. An
 observational
 study
 of
 variation 
in 
GPs'
 out‐of‐hours
 emergency
 referrals.