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Acute medical units: The way to go? A literature review

  • Author Footnotes
    1 These authors contributed equally to this work.
    L.S. van Galen
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
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  • Author Footnotes
    1 These authors contributed equally to this work.
    E.M.J. Lammers
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
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  • L.J. Schoonmade
    Affiliations
    VU University Medical Centre, Medical Library, VU University, Amsterdam, The Netherlands
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  • N. Alam
    Affiliations
    VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
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  • M.H.H. Kramer
    Affiliations
    VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
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  • P.W.B. Nanayakkara
    Correspondence
    Corresponding author at: Section Acute Medicine, Department of Internal Medicine, VU University Medical Centre, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
    Affiliations
    VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
Published:November 12, 2016DOI:https://doi.org/10.1016/j.ejim.2016.11.001

      Highlights

      • An acute medical unit (AMU) could improve patient flow and hospital quality of care.
      • Current literature shows an overall beneficial effect after implementation.
      • In the Netherlands, one-third of the hospitals have implemented an AMU.
      • Existing AMUs are designed heterogeneously, this calls for a uniform guideline.

      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
      • (1)
        Systematically provide an overview of current international literature regarding the effectiveness of AMUs
      • (2)
        Give an overview of the current situation in the Netherlands
      • (3)
        Make recommendations that could be used for future Dutch AMU guidelines

      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.

      Conclusion

      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.

      Keywords

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      Linked Article

      • Acute medical units, providing continuity of care may be the next focus
        European Journal of Internal MedicineVol. 39
      • Acute medical units, more capacity without increasing resources
        European Journal of Internal MedicineVol. 39
        • Preview
          My compliments on the review of van Galen et al. [1] concerning implementation of acute medical care units in the Netherlands. It was no easy task to investigate this diversity in wards and articles.
        • Full-Text
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      • Acute medical units, definitely the way to go
        European Journal of Internal MedicineVol. 39
        • Preview
          We thank van Galen et al. for their review of acute medical units (AMUs) [1]. The evidence presented matches our tacit experience, namely a successful model of care when measured against hard outcomes, such as length of stay, readmission rates, mortality rates and satisfaction. We agree that the best AMU solution is not yet clear. In our experience, the heterogeneity in AMUs has arisen for a multitude of reasons, often based on local service requirements and resources. Although there is variation in the implementation of AMUs in clinical practice, we strongly recommend the Royal College of Physicians of London report, ‘The right person, in the right setting — first time’, as a basic template for those wishing to develop their acute medicine service [2].
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