Acute medicine units: the current state of affairs in the North-West of England

Studies  suggest  that  acute  medicine  units  (AMU)  reduce  inpatient mortality,  length  of  stay  and  re-admissions  and  improve  four-hour  performance targets.  Over  the  past  decade  or  so,  after  evaluating  the  system  in  place,  the  Royal College  of  Physicians  of  London  (RCPL)  has  made  key  recommendations  for  an efficient and effective AMU. This audit reviews the current infrastructure of regional AMUs against those RCPL recommendations in respect of facilities, service provision and  staffing. A  total  of  22  regional  hospitals  in  the  North-West  of  England  were invited to participate in this audit; 19 responded. Two units did not have designated AMU  facilities.  Not  a  single  hospital  met  all  basic  infrastructure  recommendations. Only  four  had  the  recommended  bed  capacity,  nine  had  recommended  cardiac-monitoring  facilities  and  incorporated  ‘short-stay  units’,  13  used  early  warning systems  for  patient  triage  and  six  had  the  recommended  number  of  consultants assigned to AMUs with a designated medical team. Notably, there were suboptimal numbers of allied healthcare professionals in most units. In summary, the majority of the AMUs in the North-West of England lack sufficient resources to meet even the  most  basic  RCPL  recommendations. A  national  in-depth  audit  is  needed  to determine fully the current state and thus guide future health planning.