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Dr Jennifer Carroll, Consultant Physician, Cork University Hospital

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Primary Care - Hospital Interface
'Acute unselected medical admissions' Is there a better way?

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Dr Jennifer Carroll, Consultant Physician, Cork University Hospital

  1. 1. “acute unselected medical admissions” Is there a better way ?
  2. 2.  ? Help for HSE 374 million budget overrun
  3. 3. LEVERS FOR CHANGE• National Policy and Reconfiguration• Year on Year ED – Trolley crisis• Numbers of older more complex acute medical illness presenting to hosp• Renewed focus on Acute Medical Care• 6hr Emergency access targets
  4. 4.  Irelands only level 1 trauma centre 850 bed hospital 40 + specialties 250,000 patient episodes annually 9,000 births per year 180,000 out-patient attendances per year 3,250 multi-professional staff €250m capital development programme Large change programme being implemented
  5. 5. AMU - Cork University Hospital January 2011 opened with 23 acute medical beds Direct GP referrals from February 2011 Direct transfers from ED / Trolleys Consultant Physician continuous presence on the unit Up skilling of nursing staff Culture shared team approach promoting high quality care with proactive rapid assessment and discharge planning
  6. 6.  48 hour Length of Stay Same day Diagnostics Senior decision maker on the floor Daily specialist in each service CIT daily to facilitate discharge and handover in the community
  7. 7. AIM: Improve access for patients to prompt medical assessment by a senior clinical decision maker Uncouple the necessity for overnight admission for a procedure or investigation is a key paradigm shift Improve patient flow and reduce wait for in-patient bed.
  8. 8.  2400 acute medical patients admitted 2,065 medical patient discharges 48% discharged in 48 hours 25% in 24 hours Average length of stay 61.29 hrs Length of Stay for General Acute Medicine in hospital reduced from 10.4 - 6.5 days for first 6 months 2011
  9. 9.  1.5 WTE Consultant Physician Weekly rotation NCHD team 3 . WTE Nursing Staff 1 . WTE Care Assistant – Radiology Reconfiguration of General Ward 35 beds to 23 short stay unitCapital Infra structure rebuild 1.5 millionincluding equipment
  10. 10. AvLOS 2010 = 9.07 days V AvLOS 2011 = 7.07 daysReduction overall = 2 daysBed days Saved = 20,512 (equivalent to 56beds)Cost savings significant if allow 1100 euros per bed
  11. 11.  Initially phased opening Mon-Fri (0800hrs-2000hrs) Continuous Consultant Physician presence Same – Day Diagnostics AMU review Clinics to support same day discharge strategy
  12. 12.  2 further WTE Consultant Physician posts 3 NCHD posts ( Transfers 1 ED –CUH 2 - SIVUH ) Transfer Nursing Staff from ED /MSSU 8 trolleys for 13 bay assessment area.
  13. 13.  Transfer of Cardiology services end Nov ’11 Closure ED SIVUH 8pm – 8am end Nov ’11 Change in pathway for trauma rehabilitation to SIVUH – Dec ’11 Increased acute General Medical Activity 13% Full closure of SIVUH ED – July ’12 Transfer emergency surgery ex SIVUH - July ’12 Not a steady state at any stage in 2012
  14. 14. Number of Patients Admitted to MSSU ( other sources) 676Number of Patients Assessed in AMAU ( 981 MSSU) 3726Number of Patients Assessed in AMU Review Clinic 1158Total Number of Patients Assessed in AMU 5560
  15. 15. AM AU Discharge Outcomes 250 238 234 200 199 188 185 187 182 177 173 150 150 Di scharge d Same DayMonth Admi tte d to MSSU 115 Admi tte d to CUH 104 107 107 Transfe rre d to Othe r Hospi tal 100 103 98 94 93 90 88 90 88 80 83 79 58 60 50 23 24 11 4 6 5 4 0 0 1 2 0 1 1 Jan-12 Fe b-12 Mar- Apr-12 May- Jun- Jul-12 Aug-12 Se p-12 Oct-12 12 12 12 Number of Patients
  16. 16. AvLOS 2011 = 7.07 day V AvLOS 2012 = 6.2 daysReduction overall = approx 3 days (24+beds)
  17. 17.  Better patient care Better patient/staff experience Improved access for primary care Better clinical outcomes Appropriate clinical environment Reduced elective waiting times for admission/day cases, etc. Less trolley waits Improved efficiency Better value for money
  18. 18.  Team approach - Patient focused Continuous presence of senior clinicians on the floor Priority access to Diagnostics Partnership with Primary Care with improved access /communication
  19. 19.  Daily Consultant ward rounds 8am, 5pm and “Hot “ review Mid-day AMU Physician continual presence, no other fixed commitments AMU Physician for unit provides phone advice for primary care
  20. 20.  AMU’S improve the quality and the safety of care Reduce in-hospital length of stay Increased direct discharge rates Improved efficiency of hospital resources Greater patient and staff satisfaction
  21. 21.  Good for patients Good for service Good for tax payer
  22. 22. Success is not final, failure is not fatal: It is the courage to continue that counts. Winston Churchill

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