Improving Patient Flow with an Acute Medical Admission Unit

There are many methods for improving patient flow.  One broad category represents organizational and procedural changes that can streamline care. One common approach is to create a holding area for patients awaiting admission as an alternative to boarding patients in hall ways.  Called by various names (I like Express Admissions Unit myself), these areas complete all admitting paperwork, assessment and initial orders. Patients are housed (and cared for) here until a bed is available on the appropriate unit.  This approach relieves unit nurses the time consuming work required by newly admitted patients.  They also provide a safe patient care alternative to boarding.

Here are the results from a study at St. James' Hospital, Dublin:

For all physician teams, median LOS shortened significantly from 2002 to 2003 (6 vs. 5 days, p<0.0001). Overall, patients seen by general physicians had a shorter LOS (5 days) than that of those seen by sub-specialists (6 days) (p<0.0001). The number of patients waiting in the ED for a hospital bed was reduced by 30% from 2002 to 2003 (p<0.001). Extrapolated cost savings for the hospital with the introduction of the AMAU were estimated at approximately 4039 bed-days and {euro}1,714,152.

An alternative to a dedicated unit is a roving admitting nurse who goes with the admitted patient to their unit, relieving staff nurses from this time consuming process. Other functions can be assigned to pre admissions units that improve patient flow, for example, medical observation and evaluation units or clinical decision units. Of course, based on need and situation, effectiveness can vary.

Patient flow initiatives frequently result in seven figure annual savings.  Compared to all the hubub about questionable HIT ROIs (here and here) it's no wonder more and more hospitals are looking at many ways to improve patient flow.



  1. gary sheppard

    Hi, I’ve just read your idea of a roving admitting nurse. This would be something I may consider developing at my hospital. Is this something you have thought up or is it from another source?

  2. Gary,

    I’ll bet if you search the literature, you’ll find papers on this topic. It certainly didn’t originate with me.

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