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How is it best to deliver care in acute medical units? A systematic review.

Reid, L.E.M.; Crookshanks, A.J.F.; Jones, M.C.; Morrison, Z.J.; Lone, N.I.; Weir, C.J.


L.E.M. Reid

A.J.F. Crookshanks

M.C. Jones

N.I. Lone

C.J. Weir


The majority of medical patients presenting to hospital in the UK are cared for in acute medical units (AMUs). Such units are also increasingly present internationally. Care delivery varies across units: this review aims to examine the evidence for how best to deliver AMU care. Six electronic databases and grey literature were searched. Inclusion criteria comprised interventions applied to undifferentiated patients in AMU settings. All studies were quality assessed. A narrative approach was undertaken. Nine studies, all conducted in the UK or Ireland, evaluated 1.3 million episodes, 3617 patients and 49 staff. There was single study evidence for beneficial effects of: enhanced pharmacy care, a dedicated occupational therapy service, an all-inclusive consultant work pattern, a rapid-access medical clinic and formalized handovers. Two studies found increased consultant presence was associated with reduced mortality; one of these studies found an association with a reduction in 28-day readmissions; and the other found an association with an increased proportion of patients discharged on the day they were admitted. Three studies provide evidence of the beneficial effects of multiple interventions developed from local service reviews. Overall, the quality of the evidence was limited. This review has identified operationally relevant evidence that increased consultant presence is associated with improved outcomes of care; has highlighted the potential to improve outcomes locally through service reviews; and has demonstrated an important knowledge gap of how best to deliver AMU care. These findings have importance given the challenges acute services currently face.


REID, L.E.M., CROOKSHANKS, A.J.F., JONES, M.C., MORRISON, Z.J., LONE, N.I. and WEIR, C.J. 2018. How is it best to deliver care in acute medical units? A systematic review. QJM: an international journal of medicine [online], 111(8), pages 515-523. Available from:

Journal Article Type Review
Acceptance Date Jul 30, 2017
Online Publication Date Aug 4, 2017
Publication Date Aug 31, 2018
Deposit Date Aug 6, 2020
Publicly Available Date Aug 6, 2020
Journal QJM: an international journal of medicine
Print ISSN 1460-2725
Electronic ISSN 1460-2393
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 111
Issue 8
Pages 515-523
Keywords Consultants; Delivery of health care; Ireland; Patient readmission; Pharmacies; Mortality; Occupational therapy; Pharmacy (field); Transition of care; Narrative discourse
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