Emergency Department Models of Care 2012 - NSW Health

■■A typical patient suitable for management in a MAU is the undifferentiated complexnon-critical medical patient with co-morbidities. These patients can be streamed from:- The community (i.e. GPs, specialist rooms, ambulatory care or other identifiedcommunity referrals) directly to the MAU through predefined pathways.- ED triage direct to MAU – suitability is determined at ED triage usually by the ED nurseor doctor OR the MAU nurse or doctor.- Within the ED after a very short period of time – suitability is usually determined withinthe first hour of the ED stay by the ED nurse or doctor OR MAU nurse or doctor.The MAU model of care is to provide two streams of care:1. For those patients who go home direct from the MAU. Previously, these patientstypically stayed in hospital for 3–5 days. They can now be provided with rapidassessment, faster diagnosis and earlier treatments and sent home safely within 48hours, with community care if needed. This patient group accounts for approximately50% of all patients admitted to the MAU.2. For those patients who are transferred to a specialty ward from the MAU. Previously,these patients typically stayed in hospital for 7–9 days. They can now be provided withrapid assessments, faster diagnosis and commencement of treatment within the MAU.They are then referred to an inpatient team and transferred to an inpatient ward afterapproximately 24–48 hrs with a documented plan of care to be followed. These patientscan be sent home safely within 5–7days. This patient group accounts for approximately50% of all patients admitted to the MAU.Why use the model?Key principlesMAUs provide rapid access to an experienced multidisciplinary team at or near to the pointof entry into a hospital for undifferentiated, complex, chronic, non-critical medical patients.The MAU team aims to provide rapid assessments, faster diagnosis and earlier treatment toenable patients to return to their home environment within 48 hrs or to an inpatient ward iffurther treatment is needed.The MAU Model of care provides:■■■■Patients with rapid access to the MAU (Right Care, Right Time, Right Place, and RightProvider)Patients in the MAU with rapid assessment, faster diagnosis and earlier treatmentprovided within 48 hoursPatients who require further in-patient care, a continued management plan based ontheir initial rapid assessment, faster diagnosis and earlier treatment.Patients with safe and effective care, and ongoing care or support in their homeenvironment if needed.Benefits of the model ■ Reduction in undifferentiated, complex, chronic, non-critical medical patients presentingto the ED by providing direct referral to the MAU■■■■■Reduced length of stay in the ED for undifferentiated, complex, chronic, non-criticalmedical patientsDecreased in-hospital Length of Stay (LOS) by providing rapid assessment, fasterdiagnosis and earlier treatment at the point of entry into a hospitalReduced level of intensive investigations prior to decision-makingReduced number of patient outliers on inpatient wardsReduction in readmissions due to improved coordination and early activation forcommunity care for those patients discharged home.PAGE 46 NSW HEALTH Models of Emergency Care