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Impact of a new daily rapid access medical clinic in a Scottish district general hospital
  1. Ravi P Jamdar1,
  2. D J Beckett1,
  3. Karen Adamson2,
  4. Casey Stewart3
  1. 1Department of Acute Medicine, St John's Hospital, Livingston, UK
  2. 2Department of Acute Medicine, St John's Hospital, Livingston, UK
  3. 3Combined Assessment Unit, Department of Acute Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr R Jamdar, Acute Medicine, St John's Hospital, Howden Road West, Livingston, West Lothian EH54 6PP, UK; Jamdar{at}


Background Medical admissions to hospital in the UK are rising by approximately 10% per year. A Medical Assessment Unit (MAU) was opened to help deal with the rising influx of patients. The objectives of this study were to determine if a daily rapid access medical clinic could provide a safe alternative to hospital admission and aid safe discharge for medical patients.

Methods The rapid access clinic was embedded within the MAU, utilising existing resources. Patients were allocated and reviewed by a senior acute medicine specialist registrar (SpR). Data were collected from January to September 2008.

Results 74 patients seen in the clinic were analysed. 93% of these were managed in an ambulatory fashion, avoiding admission and saving a potential 280 bed days. The same day discharge rate of all patients seen and assessed in the MAU was increased from 17% to 26% (p<0.001), following institution of the clinic. The readmission rate fell from 8% to 4% (p=0.12).

Conclusions A daily rapid access medical clinic embedded within a MAU was piloted and allowed the safe management of a variety of medical complaints in an ambulatory fashion. It enabled an increase in the discharge rate of patients referred for admission by general practitioners. This seemed to be more robust than as evidenced previously by a trend towards lower readmission rates. These results were dependent on the presence of a senior clinical decision maker to facilitate safe discharges.

  • Acute medicine
  • acute medicine-other
  • admission avoidance, assessment, cardiac care, care systems
  • emergency care systems

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.