Abstract
Background
Reconfiguration of the Irish acute hospital sector resulted in the establishment of a Medical Assessment Unit (MAU) in Mallow General Hospital (MGH). We developed a protocol whereby certain patients deemed to be low risk for clinical deterioration could be brought by the National Ambulance Service (NAS) to the MAU following a 999 or 112 call.
Aims
The aim of this paper is to report on the initial experience of this quality improvement initiative.
Methods
The Plan-Do-Study-Act (PDSA) Cycle for quality improvement was implemented when undertaking this project. A pathway was established whereby, following discussion between paramedic and physician, patients for whom a 999 or 112 call had been made could be brought directly to the MAU in MGH. Strict inclusion and exclusion criteria were agreed. The protocol was implemented from the 1st of September 2022 for a 3-month pilot period.
Results
Of 39 patients discussed, 29 were accepted for review in the MAU. One of the 29 accepted patients declined transfer to MAU. Of 28 patients reviewed in the MAU, 7 were discharged home. One patient required same day transfer to a model 4 centre. Twenty patients were admitted to MGH with an average length of stay of 8 days. Frailty and falls accounted for 7 of the admissions and the mean length of stay for these patients was 12 days.
Conclusions
Our results have demonstrated the safety, feasibility and effectiveness of this pathway. With increased resourcing, upscaling of this initiative is possible and should be considered.
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References
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Informed consent
This study was a retrospective audit of anonymised data collected as part of routine clinical care so informed consent was not obtained.
Ethics approval
This study was carried out in accordance with the Declaration of Helsinki and was approved by the Clinical Research Ethics Committee of the Cork Teaching Hospitals (CREC).
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The authors declare no conflict of interests.
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Appendix
Appendix
Revised inclusion criteria
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1.
Ceiling of care established and patient not for escalation of care to ICU
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2.
Low risk medical patients with stable vital signs including, but not limited to the following:
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Vasovagal syncope
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Non-cardiac chest pain
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Gastroenteritis
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DVT
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Musculoskeletal pain
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3.
Patients known to MGH who have had a recent admission will also be considered if appropriate
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O’Flynn, A.M., Hart, C., Munoz-Claros, A. et al. New care pathway to enable ambulances transfer patients to a model 2 hospital medical assessment unit. Ir J Med Sci 193, 3–8 (2024). https://doi.org/10.1007/s11845-023-03438-y
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DOI: https://doi.org/10.1007/s11845-023-03438-y