Tel: 01372 735 735, Cotswold Road In addition, learning points from managing the AMU are guiding us in the development of workflows and protocols to help manage common medical conditions that require short inpatient stays. Your feedback will be used to improve the Medical Care website. The AMU continued to use an internist-led model of care, which differs from the existing specialist-led care model (Fig. The report provides a detailed description of the rationale and requirements for AMUs. As such, patients are often seen by multiple specialists and/or need to wait to see a specific specialist. Since 2009 physicians have been able to train in AIM, usually with dual certification in GIM. Our institution extended our acute medical team to form an acute medical unit (AMU), in which focused internist-led teams are stationed on site to rapidly assess and re-triage patients. The AMU initiative has allowed us to identify patient groups and diagnoses that would benefit from the new model of care and aid in resource planning for the future. In 2005, the GIM curriculum was expanded to include the then subspecialty of AIM. Acute medical care. Cotswold Fertility Unit. Our earlier study showed improved patient outcomes and resource utilisation via this model of care from April 2013 to January 2015. Audiology and audiovestibular medicine (ears), Intensive care unit (ITU) and high dependency unit (HDU), Medical Assessment Hub, AMU and Epsom Ambulatory Care, Same Day Emergency Care (SDEC) at St Helier, South West London Elective Orthopaedic Centre (SWLEOC), Stroke and transient ischaemic attack (TIA) service, Site search and information for professionals menu, > Medical Assessment Hub, AMU and Epsom Ambulatory Care. Acute care falls under the broader category of secondary care - the stage after primary care (when a patient makes first contact with medical professionals). In early 2015, our institution was faced with a challenge when a neighbouring hospital needed to scale down its services in preparation to move to a new campus. Acute care involves the treatment of patients diagnosed with short term but serious conditions - and might take place in a number of clinical settings like Accident & Emergency, Intensive Care and Neonatal Care. Hybrid roles. Nursing leadership is equally important, especially the day-to-day operational role of the nurse coordinator as described by the Society for Acute Medicine (SAM). Healthcare systems worldwide are seeing an increasing number of patients who require hospitalisation, largely due to ageing populations with multiple comorbidities as well as rising expectations of care. We aim for our medical team to see patients within two-four hours with access to specialist opinion on the medical hub within four hours on weekdays, during office hours. Epsom and St Helier University Hospitals AMU is located in A1 ward, first floor, A block. To run sustainable on-call consultant rotas, including a 7-day service, the ongoing support of these consultants to the medical take is essential and their contribution is greatly valued. The AMU model is supported by discharge enablers, including timely same-day allied health assessment reviews, follow-up by the transitional care team and rapid access to clinic appointments. The availability of specialties that can in-reach to AMU will depend on the local service provision. Those requiring longer hospital stays being transferred into specialist beds. All Rights Reserved. Fig. We hypothesised that rapid assessment, investigations and treatment offered by the AMT within the critical first few hours of admission were crucial for better outcomes. Care is delivered by a multidisciplinary team that includes: The extent to which consultants commit to the acute care of medical patients varies and comprises: A career in acute medicine has been possible since 2003 via training on a previous GIM curriculum. AMU: acute medical unit; Medicine: Department of Medicine. Hence, the AMU has led to better containment and significantly reduced scatter of medical patients, especially to surgical wards. When a patient arrives in the Acute Medical Unit, they are assessed by a dedicated team of doctors, nurses and allied health professionals. advanced nurse practitioners (ANP) either dedicated to AIM or specialty in-reach. Higher rates of early discharge (without significant differences in the readmission rates) and shorter length of stay were noted in the AMT patients, who were also more likely to be admitted into a ward specialising in their condition and have a smaller bill size compared to non-AMT patients. Being a focal point of acute activities, the AMU has allowed the department, in consultation with hospital leadership, to rationalise resource allocation. Staff who in-reach to AMU include doctors and specialist nurses. The service is open 24 hours a day, seven days a week. The capacity generated for other departments to function and continue their work also enables overall improved and smoother running of the hospital. During the initial rollout, the AMU had a functional capacity of 40 patients to allow testing and refining of the new workflows. Tel: 020 8296 2000, Dorking Road Increasingly, our allied health colleagues, such as advanced practice nurses, are getting more involved in the formulation of care plans for our patients as part of a care team. Medical Assessment Unit is located on the ground floor, adjacent to ED. (2-4) However, this care stratum is not well established in the Singapore healthcare model. 1University Medicine Cluster, National University Hospital, Singapore2Clinical Operations, Woodlands Health Campus, Singapore3Emergency Medicine Department, National University Hospital, Singapore4Department of Medicine, NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore Correspondence: Dr Goh Wei-Ping, Principal Resident Physician, University Medicine Cluster, National University Hospital, 1E Kent Ridge Road, Singapore 119074. wei_ping_goh@nuhs.edu.sg, Copyright: © Singapore Medical Association. When the AMU was first rolled out, both the medical and nursing teams needed to be reinforced to meet increased demands from both the larger volume and a wider case mix. Every AMU must be supported by a high-dependency unit, intensive care unit and coronary care unit. Print this page These internists were readily supported and advised by teams from other subspecialties, and helped to coordinate the care of the patients. support to doctors is also provided by the recent development of. Emergency and acute medical care Chapter 24 Assessment through acute medical units 5 24 Acute medical units 24.1 Introduction The Acute Medical Unit (AMU) (also often called the acute assessment unit (AAU) or medical admissions unit (MAU)) is the first point of entry for patients referred to hospital as an acute medical Copyright © Royal Colleges of Physicians 2020, Health promotion and prevention of disease, Infectious diseases and tropical medicine, Overview of acute internal medicine services. The Acute Medical Unit is a 22-bed, short-term medical / surgical unit that is designed to provide high quality and timely care for a patient's first 24-48 hours in hospital. For example, the high number of new admissions with new medication orders justified the need for an on-site pharmacist in the AMU. Fig 2: Acute medical unit: example configuration and interactions with the transfer of care (TOC) out of hospital for a majority of acute medical patients, either direct from the AMU or short stay unit. In this paper, we describe the process, outcomes and learning points from the AMU development initiative at our institution. Together, they reviewed and restructured workflows to address the expected higher patient load by improving efficiency. A number of investigations and therapeutic procedures are provided in the AMU. Ideally the AMU should be co-located with other acute and emergency services on an emergency floor (Fig 3). Investigations such as lumbar puncture should be available in every AMU. Having on-site pharmacists facilitates processes such as timely medication reviews and reconciliation, consults on medication doses and adjustments, and discharge medication preparation. Acute medical unit: experience from a tertiary healthcare institution in Singapore, https://doi.org/10.1016/j.ejim.2016.11.001, https://doi.org/10.1186/s12913-017-2491-x, Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: practical considerations for the COVID-19 pandemic. Our institution extended our acute medical team to form an acute medical unit (AMU), in which focused internist-led teams are stationed on site to rapidly assess and re-triage patients. The AMU takes over the care of patients immediately after the decision to admit is made by the ED team. Decisions about second line investigations and specialty referrals are made. (Both figures reproduced from: Royal College of Physicians. This model fosters closer working and more efficient clinical assessment and treatment by the right person, first time. Patients can receive timely access to medical interventions and stable patients can benefit from early supported discharge, anchored by the nursing, allied health and transitional care teams. Singapore’s healthcare system is under strain from the rising demands of an increasing and ageing population, resulting in delayed specialist care for patients presenting to the emergency department and requiring admission. The structure of an AMU is schematically represented in Fig 2. care coordinators and social workers) were made available to all AMU patients. The AMU acts as a gateway between a patient's general practitioner, the emergency department, and the wards of the hospital. As well as medical specialties, AIM needs to work closely with other disciplines, for example surgical specialties, obstetrics and gynaecology, intensive care medicine and psychiatry. For information on cookies and how you can disable them, please read our cookies policy. Epsom KT18 7EG Prior to specialty AIM training, many consultants trained in GIM and a specialty before joining AIM. We developed a new care delivery system: all patients that the ED assigned for admission to the Department of Medicine were admitted to this dedicated internist-led unit (Fig. High-quality nursing leadership is vital. (1) Development of acute medical units (AMUs) for rapid assessment and care has shown great benefits in some healthcare systems. One or two overnight stays - patient will be admitted to the Acute Medical Unit or specialist ward. Cardiology Ward. On admission to hospital a number of compulsory generic aspects of care are required, such as assessment and treatment for the prevention of thromboembolism. from physiotherapy, occupational therapy, speech therapy, podiatry and clinical nutrition), clinical management support (i.e. Bibury Ward. Chedworth Suite. In-reach services can occur routinely or when required. Discharge of patients directly from the AMU meant that those with mild ailments are not admitted to the inpatient wards.
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