ABSTRACT
Background: The study’s objective was to assess patient demographics, clinical quality indicators and clinical outcome of patients admitted to Brunei’s Acute Medical Unit (AMU) based on criteria listed by the British society of Acute Medicine. Methods: A retrospective cohort study of patients admitted to the AMU was undertaken. Clinical quality indicators (Seen by AMU consultant [within 14 hours], by AMU medical doctor [within 4 hours] and received Modified Early Warning Scores [MEWS] upon arrival), clinical outcomes (Length of stay, discharge within 72 hours and 30 day in-hospital mortality, readmission rates at 1 month) with Charlson co-morbidity index and Katz index of independence were collected from Brunei Health Information Management Systems (BruHIMS), from September to December 2018. Results: There were 356 admissions including male (45.2%) and female (54.8%) patients with a mean age of 51.6 (SD 18.8) years. The most common presenting complaint was fever (35.7%) and majority of patients were diagnosed with sepsis (13.5%). The median Charlson co-morbidity index and Katz index of independence were 2 (IQR 4) and 6 (IQR 0) respectively. 66.9% of patients were seen by an AMU consultant within 14 hours, 6.7% were seen by a medical doctor within 4 hours and 73.6% had their MEWS upon arrival in AMU. The 30 day in-hospital mortality rate was 0.8% and readmission rates at 1 month were 5.8%, whilst the median length of stay was 4 (IQR 3) days. Lastly, 38.3% of patients were discharged within 72 hours. Conclusion: Patients admitted to AMU were relatively fit with a low burden of disease,most commonly presenting with pneumonia, respiratory tract infections and sepsis. Patients who were assessed earlier by experienced AMU staff (AMU consultants and doctors) and had a MEWS score on arrival to AMU were associated with improved discharge rates. There is room for quality improvement in the AMU with earlier specialized review of patients, shorter length of stay and earlier discharge of patients.
Keywords: Acute Medical Unit, clinical quality indicators, patient demographics, clinical outcomes.
Corresponding author: Dr Justin Fook Siong Keasberry, MBChB (University of Otago), FRACP (General and Acute Medicine), General and Acute Medicine Physician, Acute Medical Unit Staff Specialist, Department of Internal Medicine, RIPAS Hospital, Bandar Seri Begawan BA1710, Brunei Darussalam.
Brunei Int Med J. 2020;16:128-136