Chandrasekaran Gunasekaran
St. Vincent's Hospital


Impact Of General Medicine Unit Structure On Acute Care Service Delivery Between 1996-2014

Authors: C Gunasekaran1, S Vogrin2, V Grill1, J Daffy1, N Hewitt1, P Lee1,2, E Seal1, C Ong1, C Tey1, V Roberts1, P Iser1, M Lanteri1, B Smith1, W Beswick1, V Sundararajan2, H Gock1,2
Afiliations: 1Department of General Medicine, St. Vincent’s Hospital Melbourne and 2Department of Medicine, University of Melbourne, Australia

Aims: The General Medical Department at our institution has increased in size over the past 20 years to cope with demand from originally a two clinical unit structure in 1996, to three units from 2002, then four units from 2011. We examined the trends in patient age, co-morbid disease burden and number of separations during this period. Moreover, this study also aims to assess the impact of an increase in number of units on Length of Stay (LOS), bed-days and inpatient mortality.  

Methods: Data source: Routinely collected, clinically coded, hospital data with approval for a quality assurance project. Analyses were performed using Stata 13.2.

Results: From 1996-2014, the annual separations increased 20% from 2512 to 3029.  During this period, the proportion of patients ≥75 years-old increased from 34% to 58%.  Moreover, from 2011-14, there was a substantial increase in the proportion of patients with Charlson-Comorbidity Score of ≥2 from 19% to 29%.  Despite the increase in patient volume & complexity, there was a 48% fall in annual mortality from 8.3% to 4.5% (p< 0.001) over the study period. Although the decrease in median LOS over the years was inconsistent, there was a significant drop from 5.55 to 4.65 days observed between 2012-2014. Similarly, the number of bed-days declined from 22,000 in 2011 to 20,000 in 2014.

Conclusions: Despite the increasing number and complexity of acute admissions under General Medicine, there has been a significant drop in inpatient mortality within general medical units. In the later years a decrease in median LOS and total bed-days occupied was also observed. One possible reason for this is the restructuring from 2 to 4 general medical units. To assess whether these are unique trends, further analysis of data from additional hospitals is required.