SLOWING THE RATE OF ACUTE MEDICAL ADMISSIONS

We studied the effectiveness of a dedicated medical receiving room (MR R) with senior registrar (SR) assessment of CP requests for medical ad mission. In the first of three 16-week study periods, patients were as sessed by senior house officers or registrars. In the second period, p atients were assessed by a single SR. In the third period, nine SRs ma nned the MRR on a rota. Outcome measures included same-day discharge r ate, use of specialist beds and 28-day readmission rate. A questionnai re was sent to general practitioners (GPs) of patients discharged in p eriod three to assess their satisfaction with the service. The same-da y discharge rate increased from 3.6% in period one to 29% in period tw o (p < 0.001) and 15% in period three (p < 0.001). The use of speciali st and off-site beds also increased from 1.2 per week in period one to 2.9 in period two and 3.1 in period three. The 28-day readmission rat e was 13.3% in period one, 6.9% in period two and 6% in period three. The GPs were satisfied with the service provided by the MRR and all fe lt that the discharge was appropriate. Assessment of GP referrals for acute medical admission by SRs in a MRR allows more patients to be saf ely discharged on the same day than if the assessment is carried out b y a more junior doctor. SRs also direct more patients to the relevant specialty, so improving patient care and effective use of available be ds.