RESUMO
OBJECTIVE: To examine patterns of acute medical emergency admissions and the effect of reorganisation on their management. DESIGN: Examination of statistics for emergency medical admissions from 1992 to 1997, a period that included a major reorganisation of the emergency admitting system within the hospital. SETTING: General hospital in a Scottish conurbation. RESULTS: There was a slow annual increase in numbers of admissions during the period of study with very considerable variations in daily and weekly numbers of admissions. Reorganisation achieved a reduction in average length of stay from seven to 4.5 days permitting reduction of the bed complement from 223 to 161. Following reorganisation, 31% of admissions were discharged home within 48 hours directly from the acute medical receiving ward, 18% of admissions were transferred directly to care of the elderly, and 33% of admissions were transferred to medical wards. Patient and staff satisfaction surveys indicated preference for the new system over the old. Admission peaks over the winter months of the last three years occurred at different weeks in the year. CONCLUSIONS: Reorganisation of the medical admitting system can improve efficiency and allow reductions in staffed beds. The considerable [table: see text] variation in daily demands in the system makes it important to retain flexibility. There may be scope for dealing with the large numbers of short-term admissions in other ways.
