Follow-up pathways, investigation utilisation, and general practitioner communication following acute medical unit assessment: A six-month retrospective service evaluation.

BACKGROUND

Acute Medical Units (AMUs) provide rapid assessment of acute medical presentations between the Emergency Department and inpatient services. Communication with general practitioners (GPs) at discharge underpins continuity of care, yet post-discharge processes within AMU ambulatory pathways are seldom evaluated.

AIMS: To evaluate patient flow, structured follow-up arrangements, outpatient investigation use, and documented discharge communication to GPs across the acute assessment and hot clinic pathways of an AMU service.

METHODS

Retrospective service evaluation of 734 patient episodes (493 acute assessment; 241 hot clinic) over six months (October 2023-March 2024) at a Model 4 Irish tertiary hospital. Variables were extracted from routinely maintained AMU service records and analysed using IBM SPSS Statistics version 22, with chi-square testing for between-pathway comparisons.

RESULTS

Neurology was the commonest clinical category in both cohorts (232/493 [47.1%] acute; 71/241 [29.5%] hot clinic). Following acute assessment, 243/493 (49.3%) continued under AMU follow-up and 53/493 (10.8%) were admitted; in the hot clinic cohort, 125/241 (51.9%) continued under AMU follow-up and 10/241 (4.1%) were admitted. Follow-up completion was high (440/493 [89.2%]; 213/241 [88.4%]). Documented GP discharge communication among discharge-eligible episodes was low, and significantly lower in the hot clinic pathway (184/437 [42.1%] vs 47/231 [20.3%]; p < 0.001).

CONCLUSIONS

AMU ambulatory pathways achieved high follow-up completion and low admission rates, but documented discharge communication to general practice was poor, particularly in the hot clinic pathway. Integrating hot clinic encounters into electronic discharge workflows is a priority for quality improvement.