Impact of an acute medical admission unit on length of hospital stay, and emergency department 'wait times'

Background: While many UK hospitals have introduced an acute medical admissions unit (AMAU) to facilitate an efficient emergency admission process and reduce length of hospital stay (LOS), there is a lack of such data in the Republic of Ireland Aim: To determine the impact of an AMAU on emergency department (ED) wait times for a hospital bed, consultant practice, and LOS. Design: Retrospective analysis of data recorded in the hospital in-patient enquiry (HIPE) system. Methods: We studied all emergency medical patients admitted to St James' Hospital Dublin between 1 January 2002 and 31 December 2003. In 2002, patients were admitted directly to a variety of wards, many of which were not affiliated with a medical specialty, under the care of a named consultant physician. In 2003, two centrally located wards were re-configured to function as an AMAU, and all emergency patients were admitted to this unit. Results: For all physician teams, median LOS shortened significantly from 2002 to 2003 (6 vs. 5 days, p < 0.0001). Overall, patients seen by general physicians had a shorter LOS (5 days) than that of those seen by sub-specialists (6 days) (p < 0.0001). The number of patients waiting in the ED for a hospital bed was reduced by 30% from 2002 to 2003 (p < 0.001). Extrapolated cost savings for the hospital with the introduction of the AMAU were estimated at approximately 4039 bed-days and e1 714 152. Discussion: Introduction of the AMAU speeded access to acute medical service and reduced costs.