A new paper published in the Future Healthcare Journal (FHJ) describes how a structured quality improvement programme helped to bring one acute medical unit up to national standards.
In Leading from the acute medical unit: restoring function, purpose and flow, Dr Anika Wijewardane, a consultant physician in acute internal medicine and stroke medicine at Frimley Health NHS Foundation Trust, and Dr Philip Dyer, a consultant physician in diabetes, endocrinology and acute internal medicine at University Hospitals Birmingham NHS Foundation Trust, discuss how daily multidisciplinary board rounds, real-time operational oversight and redesigned rotas helped one team return to the core principles of acute medicine.
Many NHS hospitals are navigating intense and sustained pressure across urgent and emergency care. By early 2023, it was clear that the acute medical unit (AMU) at Frimley Park Hospital was no longer functioning as intended. National standards for an AMU emphasise early senior review of patients, coordinated multidisciplinary assessment and structured operational processes, but we had drifted from these fundamentals.
Our FHJ article describes how we approached this challenge, what we learned, and why returning to core acute medicine principles made such a difference.
Recognising the problem
Only around 30% of our acute medical admissions were coming through the AMU, which meant that many patients were bypassing the very part of the hospital designed to deliver timely, effective acute care. Daily discharges on the AMU were low, around five per day, and the average length of stay had crept beyond 3 days. Consultant ward rounds often stretched into the afternoon, delaying decisions, and multidisciplinary team (MDT) coordination was inconsistent.
This wasn’t due to a lack of effort or commitment. It was the cumulative result of operational drift and rising workload. But it was clear that unless we reset the AMU to its core function, we wouldn’t be able to improve patient flow, safety or experience.
Designing a different approach
Working closely with our improvement team, we developed a structured programme to restore core AMU principles, using Getting It Right First Time and Society for Acute Medicine recommendations as a framework.
The first key change was introducing a daily ‘command-and-control’ board round at 11.30am. A nurse in charge leads this, along with a consultant acute physician, our therapists, pharmacist, discharge coordinator, administrative colleagues and representation from the site team. We use the same structure for every patient: diagnosis, MDT plan, estimated discharge date and likely next destination.
It may sound simple – but committing to that level of clarity for each patient every single day was transformational. It helped us shift our mindset to ‘drive today’s work today’.
The second major change was enabling a change in the consultant rota to match peak activity. This allowed us to improve our consultant: patient ratio on the AMU from 1:21 to 1:14 in the morning, enabling earlier senior decision making that fed directly into the board round.
What we achieved
Over the following months, the impact exceeded our expectations:
- Our AMU length of stay halved, from around 3.5 days to 1.9 days, sustained to date.
- Daily discharges more than doubled – from five per day to over 12.
- 63% of patients are now discharged home directly from the AMU.
- Patients who began their care on AMU had a total hospital stay 1.19 days shorter than those admitted straight to base wards.
- Even our 4-hour performance improved significantly, with more patients enabled to move from the emergency department (ED) to the AMU.
Just as importantly, staff report stronger MDT collaboration and a renewed sense of shared purpose. The board round has become the anchor of our day, giving us structure, clarity and momentum, and has helped many of us to rediscover the joy in acute medicine.
Why does this matter?
Innovation isn’t always about doing something new. More often, it’s about doing the right things, every day, consistently. When the AMU runs the way that it’s meant to, more patients can be assessed, managed and safely sent home within 72 hours. That takes pressure off the ED and the wards – and the whole hospital flows better.
And for the patients who do need longer in hospital, getting them stabilised early and having a clear plan from the start means that their overall stay is shorter too. Coming back to the core principles of acute medicine made our care safer, faster and more coordinated across the hospital.
I hope that our experience adds to the shared learning for organisations.
When the basics are in place and the MDT is aligned, the AMU can help to steady the whole system, even when everything else feels tough.
Read the full article in the latest issue of the RCP journal, FHJ
Read Voice of physicians, our 2025 RCP emerging themes report
Dr Anika Wijewardane
Consultant physician in acute internal medicine and stroke medicine
