Whole-of-hospital approach needed to fix access block
Australian hospitals need a “whole-of-hospital” approach, including the introduction of acute medical assessment and admission units (AMAAUs), to reduce the problem of patient admission access block, according to an article published in the Medical Journal of Australia.
Article author Prof Haydn Walters, Professor of Medicine at the University of Tasmania and Menzies Research Institute, and clinical chief of medicine at Royal Hobart Hospital, has been studying British hospital reforms for the past six months.
His co-author, Prof David Dawson, is a consultant in health care change management at Sheffield in the UK.
Prof Walters said patients who were expected to stay in British public hospitals for longer than four hours were quickly transferred from the accident and emergency department to the AMAAU, freeing up accident and emergency staff.
“AMAAUs require the supervision of a new style of acute general physician who drives timely management of acute medical patients, defines patient needs, estimates the likely date of discharge, and selects the most appropriate inpatient clinical stream,” Prof Walters said.
“Patients admitted to the AMAAU undergo rapid nursing assessment and initiation of investigations by junior doctors. When early data are available, a timely senior review of a patient’s condition is made to formulate a provisional diagnosis and management plan, and designate an inpatient clinical stream, likely length of stay and most appropriate ward destination. These downstream services also need to be ready and willing to look after acutely ill patients.”
Prof Walters said establishing AMAAUs was expensive, but the cost was recovered by major efficiencies in length of stay, bed utlisation and clinical outcomes.
“Australian hospitals have much to gain by embracing many of the reforms that have been introduced in the UK,” Prof Walters said.
“Unless we make changes not only in the way emergency departments are run, but to the whole acute medicine process, more and more acute beds will be needed to cope with the number of medical patients and the acute nature of their conditions.”
The Medical Journal of Australia is a publication of the Australian Medical Association.
The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.
CONTACT:
Prof Haydn Walters 0419 770 086