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      An Acute Medical Unit in a Korean Tertiary Care Hospital Reduces the Length of Stay and Waiting Time in the Emergency Department

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          Abstract

          A hospitalist-run acute medical unit (AMU) opened at a tertiary care hospital on August 2015 for the first time in Korea. Patients visiting the emergency department (ED) with acute medical problems are admitted to the AMU. They stay in that unit for less than 72 hours and are discharged or transferred to specialty wards if longer treatment is necessary. We reviewed 19,450 medical admissions through the ED from January 2014 to September 2016. The median length of stay (LOS) significantly decreased from 10.0 days (interquartile range [IQR], 5.5–16.7) to 9.1 days (IQR, 5.1–15.0) ( P < 0.001) after the establishment of the AMU. The median waiting time in the ED significantly shortened by 40% ( P < 0.001). Future studies on the impact of AMU on in-patient morbidity, mortality, re-admission rate, and patient or staff satisfaction are necessary.

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          Most cited references18

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          The emerging role of "hospitalists" in the American health care system.

          Robert M. Wachter, Lee Goldman (1996)
          Article 0 comments Cited 74 times – based on 0 reviews     Review now
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            Zero to 50,000 - The 20th Anniversary of the Hospitalist.

            Robert M. Wachter, Lee Goldman (2016)
            Article 0 comments Cited 65 times – based on 0 reviews     Review now
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              Effectiveness of acute medical units in hospitals: a systematic review.

              Ian Scott, Louella Vaughan, Derek Bell (2009)
              To assess the effectiveness of acute medical units (AMUs) in hospitals. (i) Controlled and observational studies in peer-reviewed journals retrieved from PubMed, EPOC, CINAHL and ERIC databases published between January 1990 and July 2008; and (ii) reports from non-peer-reviewed websites combined with Google search. Articles reporting effects of the introduction of an AMU on mortality, length of stay, discharge disposition, readmissions, resource use and patient and/or staff satisfaction. Data extraction Data on unit operations and outcome measures were extracted by a single author and confirmed by a second author, with disagreement settled by consensus. Nine peer-reviewed reports of before-after analyses of seven units introduced into the UK and Ireland were analysed. Two studies, one prospective, reported significant reductions in in-patient mortality between 0.6 and 5.6% points following commencement of AMU. Four studies reported significant reductions in the length of stay between 1.5 and 2.5 days. Waiting times for patient transfer from emergency departments to medical beds decreased by 30% in one study. In three studies, the proportion of medical patients discharged directly home from the AMU increased by 8-25% points. Three studies noted no increase in 30-day readmission rates following unit commencement. Two studies described significant improvements in patient and staff satisfaction with care. Eight non-peer-reviewed reports relating to 48 units confirmed reductions in the length of stay. Limited observational data suggest AMUs reduce in-patient mortality, length of stay and emergency department access block without increasing readmission rates, and improve patient and staff satisfaction.
              Article 0 comments Cited 47 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Korean Med Sci
                Journal ID (iso-abbrev): J. Korean Med. Sci
                Journal ID (publisher-id): JKMS
                Title: Journal of Korean Medical Science
                Publisher: The Korean Academy of Medical Sciences
                ISSN (Print): 1011-8934
                ISSN (Electronic): 1598-6357
                Publication date (Print): December 2017
                Publication date (Electronic): 20 October 2017
                Volume: 32
                Issue: 12
                Pages: 1917-1920
                Affiliations
                [1 ]Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
                [2 ]Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea.
                [3 ]Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
                Author notes
                Address for Correspondence: Hak C. Jang, MD, PhD. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173-beon-gil, Bundang-gu, Seongnam 13620, Republic of Korea. janghak@ 123456snu.ac.kr

                *Jung Hun Ohn and Nak-Hyun Kim contributed equally to this work.

                Author information
                https://orcid.org/0000-0001-5415-4505
                https://orcid.org/0000-0003-1134-1364
                https://orcid.org/0000-0002-6024-5777
                https://orcid.org/0000-0002-4751-9817
                https://orcid.org/0000-0002-3540-0202
                https://orcid.org/0000-0001-7556-1070
                https://orcid.org/0000-0001-7615-8611
                https://orcid.org/0000-0001-7132-0157
                https://orcid.org/0000-0002-4188-6536
                Article
                DOI: 10.3346/jkms.2017.32.12.1917
                PMC ID: 5680488
                PubMed ID: 29115071
                SO-VID: 63386dbb-1a24-4b90-b1b6-f16fbedae973
                Copyright © © 2017 The Korean Academy of Medical Sciences.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 01 June 2017
                Date accepted : 05 September 2017
                Funding
                Funded by: Seoul National University Bundang Hospital;
                Award ID: 02-2016-041
                Categories
                Subject: Original Article
                Subject: Medicine General & Social Medicine

                ScienceOpen disciplines: Medicine
                Keywords: hospital medicine,length of stay,hospitalists,emergency service, hospital
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: hospital medicine, length of stay, hospitalists, emergency service, hospital

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