Emergency Department Models of Care 2012 - NSW Health

Challenges ■ Identification of ‘MAU-appropriate patients’ prior to or at entry into the hospital■■■■Community and ED staff education about patient suitability for the MAUED MAUs are used as an overflow unit when the ED is busyMAU used as a holding bay until ward beds become availableMAU used for acute inpatient admissions when inpatient beds are not available.Case for implementationWhat you need to runthe modelTo assess the need to implement this model to support your ED and hospital, consider thefollowing:■■■■■■Does your ED experience inefficient patient flow?Are medical patients managed for extended periods in the ED?Is there good coordination of care for medical patients with the community?Is your hospital meeting the 4-hour National Emergency Access Target?What proportion of ED presentations are undifferentiated, complex, chronic, non-criticalmedical patients?What is the readmission rate for the complex medical patients in your hospital?Governance■■Executive sponsor (i.e. General Manager) who states, models and reinforces that theMAU model of care is critical to the success of the whole hospitalMAU Executive Management Committee that meets regularly and is able to action issuesimmediately. This Committee will include representatives from the hospital Executive,Patient Flow, ED-medical and nursing, MAU medical, nursing and allied health.Medical staff:■■■Medical Director specifically dedicated to the MAU to provide clinical leadership,governance and medical services for patients in the MAU. The provision of seniorphysician cover and presence in the MAU is vital for its success.Admitting medical officer (AMO) dedicated/on-take/rotating to accept patients rapidlyinto the MAU either from the community, at ED Triage or from within the ED.Dedicated medical staffing (CMO, Registrar level) for the MAU to provide immediateaccess to medical assessment and to accept patients directly into the MAU, or enabletransfer from ED within a short period of time.Nursing staff:■■■Nursing Unit Manager (NUM) to lead the MAU team. The size of the bed-base orco-location to another ward will determine if the NUM is dedicated to the MAU only orhas another unit/ward responsibilitiesCare Coordinator position. Ideally a Nurse Practitioner (NP) or Clinical Nurse Consultant(CNC) who is responsible for coordinating care across the patients’ journey (inclusive ofpre- and post-MAU) in collaboration with the multidisciplinary team.The current 1:4 nurse patient ratio is recommended for the MAU due to the patientcohort (undifferentiated, complex, chronic, non-critical medical patients) and high patientturnover (48-hour length of stay).Allied Health staff:■■Allied Health staff are critical to the functioning of the MAU and in providingcoordinated care at the point of entry into the hospital to promote patient function andto expedite patient assessment, treatment, referral and discharge.Allied Health staff should be dedicated to the MAU and not allocated on a rotationalbasis or daily/weekly/monthly batching from the Allied Health department.Models of Emergency Care NSW HEALTH PAGE 47