Clin Med
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A cornerstone of the development of acute medicine has been the principle of consultant presence within the acute medical unit (AMU). There is the hypothesis that consultant supervision improves patient care. This view is not currently supported by firm scientific evidence. ⋯ Overall length of stay was significantly lower, by a mean of 1.3 days, when there was a consultant present, and 9% more patients were discharged on the same day of their assessment (95% confidence interval 5.7% to 12.6%, p < 0.001) without affecting readmission or mortality. These results suggest the absence of a consultant leads to fewer same-day discharges and causes the inappropriate admission of patients not needing inpatient management. Further study is required to determine whether these findings are shared by other AMUs.
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This study aimed to evaluate timeliness of an outpatient urgent access neurovascular clinic in a district general hospital setting through an audit of delay from event to completion of evaluation following transient ischaemic attack (TIA) or minor stroke. Participants included those referred for evaluation of suspected TIA or minor stroke. ⋯ A weekly TIA clinic is not capable of achieving the National Clinical Guidelines for Stroke recommendation for evaluation within one week of symptoms. This audit supports the National Stroke Strategy recommendation for immediate evaluation of patients presenting with a recent TIA or minor stroke.