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Health Bull (Edinb). 1997 May;55(3):176-84.

Coping with the inexorable rise in medical admissions: evaluating a radical reorganisation of acute medical care in a Scottish district general hospital.

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Royal Alexandria Hospital, Paisley.



To describe radical changes in acute medical care in a district general hospital and assess their impact on staff and patients.


A before and after comparison of structure, process and outcome indicators in the year preceding and following reorganisation.


The Adult Medicine Clinical Directorate of the Royal Alexandra Hospital in Paisley, Scotland.


Staff in the Medical Directorate and a random sample of 400 patients.


The main stimulus for reorganisation was the pressure caused by a relatively steep rise in admissions. In response, the six existing general medical wards were converted into a 38-bed Medical Admissions Unit and five more specialised wards. A new acute receiving rota allowed each consultant to concentrate almost exclusively on acute receiving for one week at a time.


The boarding of patients in non-medical wards was eliminated through improved bed management. The needs of patients became better matched to the specialism of their consultant. The cardiologist's share of in-patients with cardiological problems rose from 34% of 2,877 cases to 58% of 3,085 cases (p < 0.001) and the respiratory physicians' share of respiratory in-patients grew from 53% of 1,281 cases to 67% of 1,287 cases (p < 0.001). After the reorganisation, medical staff had significantly fewer concerns about losing track of patients (p < 0.01) or about boarding (p < 0.01), however, concern about 'blocked beds' became greater (p < 0.05). Nurses reported more time for health promotion (p < 0.01) but also a rise in stress (p < 0.05). More patients reported that staff had time to explain their treatment (85/109 (79%) before, 93/105 (89%) after, p < 0.05) and a higher proportion felt ready for discharge (91/108 (84%) before, 99/106 (93%) after, p < 0.05).


Radical reorganisation of medical care in response to rising acute medical admissions is achievable and may lead to improvements in care.

[Indexed for MEDLINE]

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