Using the AMAU pathway as an alternative to the “admission-to-investigate” pathway

Abstract

Background / Problem Identified: Acute Medical Assessment Units (AMAU) were created with the main goal of providing medical patients with prompt, consultant-led decision making. According to the 2010 HSE National Acute Medicine Programme, a decision should be made regarding admission or discharge for AMAU patients (time to decision) in less than 6 hours. The aim of our Acute Medical Assessment Unit is to provide a service that enables early patient assessment and prioritisation of investigations leading to a reduced patient experience time (PET) on the emergency department floor. The AMAU will also provide an alternative pathway for follow-up in patients not requiring acute admission – with scheduled follow up of planned investigations in the AMAU clinic or Virtual Ward. Complementary investigations play a key role in decision making. Prioritisation of urgent investigations to determine acute management (Priority 2 e.g. CTPA for a suspected PE with a high Wells’ score) and less urgent investigations (Priority 3 e.g. endoscopy for gastritis) can be decided and followed-up via the AMAU. Lack of timely access to these investigations can lead to an undue delay in patient flow and obstruct potentially safe patient discharges. The Mercy AMAU was restructured in July 2020. This resulted in the addition of a fixed medical SHO, CNM2, and clerical officer; along with 2 Consultants who supervise the unit. There is additional support provided with an SHO and Medical Registrar from another team. A GP referral pathway was introduced to further expedite patient assessment in November 2020. This AMAU Audit aims to ascertain to what extent the AMAU activity reduces the number of hospital admissions that are required to facilitate access to timely investigations.