Effects of a medical admission unit on in-hospital patient flow and clinical outcomes

•Inappropriate in-hospital settings increase clinical risk for acute medical patients.•A Medical Admission Unit run by Internists redesigned the acute patient flow.•MAU ensured a high turn-over downsizing the outlying phenomenon.•MAU centralised unstable medical patients reducing in-hospital mortali...

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Bibliographic Details
Published in:European journal of internal medicine 2024-09, Vol.127, p.105-111
Main Authors: Canetta, Ciro, Accordino, Silvia, La Boria, Elisa, Arosio, Gianpiero, Cacco, Silvia, Formagnana, Pietro, Masotti, Michela, Provini, Stella, Passera, Sonia, Viganò, Giovanni, Sozzi, Fabiola
Format: Article
Language:English
Subjects:
Acute medical unit
Clinical risk
In-hospital mortality
Medical admission unit
Medical outliers
Patient flow
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Summary:•Inappropriate in-hospital settings increase clinical risk for acute medical patients.•A Medical Admission Unit run by Internists redesigned the acute patient flow.•MAU ensured a high turn-over downsizing the outlying phenomenon.•MAU centralised unstable medical patients reducing in-hospital mortality.•A patient-centred and problem-oriented approach lowers clinical risk. the burden of acute complex patients, increasingly older and poli-pathological, accessing to Emergency Departments (ED) leads up hospital overcrowding and the outlying phenomenon. These issues highlight the need for new adequate patients’ management strategies. The aim of this study is to analyse the effects on in-hospital patient flow and clinical outcomes of a high-technology and time-limited Medical Admission Unit (MAU) run by internists. all consecutive patients admitted to MAU from Dec-2017 to Nov-2019 were included in the study. The admissions number from ED and hospitalization rate, the overall in-hospital mortality rate in medical department, the total days of hospitalization and the overall outliers bed days were compared to those from the previous two years. 2162 patients were admitted in MAU, 2085(95.6%) from ED, 476(22.0%) were directly discharged, 88(4.1%) died and 1598(73.9%) were transferred to other wards, with a median in-MAU time of stay of 64.5 [0.2–344.2] hours. Comparing the 24 months before, despite the increase in admissions/year from ED in medical department (3842 ± 106 in Dec2015–Nov2017 vs 4062 ± 100 in Dec2017-Nov2019, p
ISSN:0953-6205
1879-0828
1879-0828
DOI:10.1016/j.ejim.2024.05.001