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

12 november 2016

van Galen LS, Lammers EM, Schoonmade LJ, Alam N, Kramer MH, Nanayakkara PW

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.

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