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Effect of an acute medical admission unit on key quality indicators assessed by funnel plots
  1. Edward D Moloney1,
  2. Kathleen Bennett2,
  3. Bernard Silke1
  1. 1
    Division of Internal Medicine, St James’ Hospital, Dublin, Ireland
  2. 2
    Department of Therapeutics and Pharmacology, Trinity Centre at St James’ Hospital, Dublin, Ireland
  1. Dr Bernard Silke, Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James’ Hospital, James’ Street, Dublin 8, Ireland; silkeb{at}tcd.ie

Abstract

Objective: To determine the effect of the introduction of an acute medical admissions unit (AMAU) on key quality efficiency and outcome indicator comparisons between medical teams as assessed by funnel plots.

Methods: A retrospective analysis was performed of data relating to emergency medical patients admitted to St James’ Hospital, Dublin between 1 January 2002 and 31 December 2004, using data on discharges from hospital recorded in the hospital in-patient enquiry system. The base year was 2002 during which patients were admitted to a variety of wards under the care of a named consultant physician. In 2003, two centrally located wards were reconfigured to function as an AMAU, and all emergency patients were admitted directly to this unit. The quality indicators examined between teams were length of stay (LOS) <30 days, LOS >30 days, and readmission rates.

Results: The impact of the AMAU reduced overall hospital LOS from 7 days in 2002 to 5 days in 2003/04 (p<0.0001). There was no change in readmission rates between teams over the 3 year period, with all teams displaying expected variability within control (95%) limits. Overall, the performance in LOS, both short term and long term, was significantly improved (p<0.0001), and was less varied between medical teams between 2002 and 2003/04.

Conclusions: Introduction of the AMAU improved performance among medical teams in LOS, both short term and long term, with no change in readmissions. Funnel plots are a powerful graphical technique for presenting quality performance indicator variation between teams over time.

  • acute medical admission unit
  • funnel plots

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Footnotes

  • Competing interests: None declared

  • Abbreviations:
    AMAU
    acute medical admissions unit
    CI
    confidence interval
    HIPE
    Hospital In-Patient Enquiry
    ICD-9-CM
    International Classification of Diseases, ninth revision, Clinical Modification
    IQR
    interquartile range
    LOS
    length of stay
    PAS
    patient administration system
    SJH
    St James’ Hospital

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