Acute medicine is a challenging and demanding specialty not just in terms of high turnover of patients but also the patient safety. The priority for the on call medical team is to ensure smooth patient flow, but also to ensure patients are reviewed by senior clinicians as early as possible to make best clinical decisions.
Several factors are incorporated in smooth running of the medical take including: perceived appropriateness of medical referral; appropriate allocation of patients for clerking based on skill set of junior doctors; timely post take ward round, reducing the burden on medical registrar, and avoiding handing over a large number of patients to the night team.
In order to address some of these key parameters we created a medical coordinator (MC) who acts as a single point of contact between emergency department(ED) and Acute Medical Unit (AMU) for medical referrals between 12 noon until 10 pm, Monday to Friday.
Besides accepting referrals from ED and assigning junior doctors to patients in a timely manner for clerking, MC also ensures appropriate investigations are requested prior to a patient being accepted by the medical team. Consultant on call is made aware of patients to be reviewed and usually a junior doctor is tagged for jobs generated out of post take ward round.
We conducted a staff survey to look at whether the medical coordinator improved patient safety by reducing the time between junior to consultant review. The results are plotted in the graph (Fig. 1) below. They show a considerably shortened time when there is a medical coordinator – 42 minutes from junior to consultant review with a medical coordinator, and 1 hour and 46 minutes without a medical coordinator.
We also looked at clinician satisfaction from both the ED and AMU by handing out staff questionnaires – 36/41 medics and 18/30 ED staff (doctors and nurses) replied. All 36 of the medics who replied felt that a medical coordinator did the following:
- Improved patient flow
- Appropriately allocated patients to doctors in a timely manner
- Shortened time to clinical review
- Improved efficiency of team work
- Ensured good patient flow when doctors were on their break
- Improved patient safety
- Reduced the number of patients handed over to be seen by the night team
All 18 of the ED members who replied felt that a medical coordinator:
- Eased patient referral
- Ensured timely and appropriate investigations were requested prior to acceptance of referral
- We needed a medical coordinator over the weekend (for 7 day service)
In conclusion, our survey shows that a medical coordinator improves patient safety by shortening the time from junior to consultant review, and improves the efficiency and flow of the medical take. Our aim is to expand the services to 7 day service and thereby ensure patient safety and thereby help medical team run a smooth medical take.
First author: Dr Syed Basharath Mehdi, Correspondence email: [email protected]
Other contributors: Dr Stephen Gulliford, Dr Debbie Wing, Dorothy Hallam, Barbara Peet Institution: Wrightington, Wigan and Leigh NHS Foundation Trust