Slowing the rate of acute medical admissions

We studied the effectiveness of a dedicated medical receiving room (MRR) with senior registrar (SR) assessment of GP requests for medical admission. In the first of three 16-week study periods, patients were assessed by senior house officers or registrars. In the second period, patients were assessed by a single SR. In the third period, nine SRs manned the MRR on a rota. Outcome measures included same-day discharge rate, use of specialist beds and 28-day readmission rate. A questionnaire was sent to general practitioners (GPs) of patients discharged in period three to assess their satisfaction with the service. The same-day discharge rate increased from 3.6% in period one to 29% in period two (p < 0.001) and 15% in period three (p < 0.001). The use of specialist 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 rate 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 felt that the discharge was appropriate. Assessment of GP referrals for acute medical admission by SRs in a MRR allows more patients to be safely discharged on the same day than if the assessment is carried out by a more junior doctor. SRs also direct more patients to the relevant specialty, so improving patient care and effective use of available beds.