Admissions from the Emergency Department (ED) to the
Medical Admissions Unit (MAU) - an analysis of repetition of
data collection. Is it time to streamline the admissions process?
Vicky Robins, Serwaa McClean, Natalie Gray, Sulleman Moreea
Background
We aimed to determine the extent of avoidable repetition of data
collection with a view to developing a clerking sheet aimed at
streamlining the admissions process from the ED to the MAU.
Methods
•30 case notes were reviewed by 3 investigators looking at 84
parameters to determine what information was collected by each staff
member for patients admitted to MAU via the ED and the degree to
which this information improved during the admissions process
• A grading system of 1-4 was used to classify the degree of
improvement, with 1 being no improvement and 4 being significant
improvement
• 6 nursing and doctors’ proformas from around the local area were
compared and the best points from each collated to form a proposed
proforma to streamline the admissions process form ED to MAU.
Average improvement and no. of times collected
for data it was felt necessary to repeat
Average improvement and no. of times collected for
data expected to remain constant
Average no. of times collected
Degree of improvement
Average no. of times collected
Figure 1a
Degree of improvement
Figure 1b
Figure 1a and 1b
Figure 1a Parameters that we would expect to have to repeat, for example, examination showed little improvement in quality.
Figure 1b Information that was repeatedly asked that we would not expect to change during the course of an acute admission
demonstrated little improvement from the ED to MAU
Figure 2. Proposed modified clerking proforma
Results
Information was collected up to 6 times. Unnecessary repetition occurred when recording the following (average
values): NOK details (x2.8), allergies (x4.5), past medical history (x3.6), reason for admission (x4.8). Information
that was commonly collected such as demographics and drug history remained constant. The degree of
improvement was most obvious in investigations ordered/management plan, clinical impression and drug history,
however, there was no significant change. Only minor changes were recorded in smoking and alcohol history.
The majority of the information did not change from the ED doctors clerking. The areas of best practice from
each of the local proformas was collated (see table 1.)
Section of
Proforma
General
Layout
Good Points
Presentable, easy on the eye,
easy to follow, all relevant
sections included
Poor lay out
Illogical order
Space
Drug history
Adequate space
Relevant prompts e.g. over
counter
Too lengthy
Too prescriptive e.g. HRT, Chemo, ,
nasal preparations
Examination
Results
Relevant prompts
Relevant spaces to encourage
documentation
CXR diagram to annotate
Senior review Adequate space
Consultant
Structured, checklist,
review
Nursing notes Combined assessments
general
Free sheets at back
Bad points
Too prescriptive
Big tables for bloods
Limited space
Inadequate free space text, too
many check boxes
Lengthy, repetitive, poor quality
Sections go over page boundary
Table 1. Tabulation of good points and bad points of local clerking proformas
Recommendations
• Implementation of streamlined clerking proforma (figure 2)
• Use information technology to streamline the admissions
process
• Information which is constant should be recorded only once
and saved as an electronic record
• Avoid unnecessary repetition, encourage staff to work as
teams and put trust in each other’s work.
Contact: Vicky Robins, Patient Safety Leadership Fellow,
[email protected], tel: 01274 383943