Evaluation of the impact of implementation of a Medical Assessment and Planning Unit on length of stay
Caroline A. Brand A B C J , Marcus P. Kennedy D E , Bellinda L. King-Kallimanis F , Ged Williams G , Christopher A. Bain H and David M. Russell C IA Centre for Research Excellence in Patient Safety (CREPS), Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
B Clinical Epidemiology & Health Services Evaluation Unit (CEHSEU), Royal Melbourne Hospital, Royal Park Campus, Park House, Parkville, VIC 3050, Australia.
C Department of Medicine, University of Melbourne, Parkville, VIC 3052, Australia.
D Adult Retrieval Victoria, Ambulance Victoria, PO Box 2000, Doncaster, VIC 3108, Australia. Email: marcus.kennedy@ambulance.vic.gov.au
E Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia.
F Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands. Email: b.l.kallimanis-king@amc.uva.nl
G Nursing and Midwifery Services, Gold Coast Health Service District, 108 Nerang Street, Southport, QLD 4215, Australia. Email: ged_williams@health.qld.gov.au
H Health Informatics Society of Australia, 413 Lygon Street, Brunswick East, VIC 3057, Australia. Email: bainchri@optusnet.com.au
I Department of General Medicine, Royal Melbourne Hospital (RMH), 4 West, Grattan Street, Parkville, VIC 3050, Australia. Email: david.russell@mh.org.au
J Corresponding author. Email: caroline.brand@mh.org.au
Australian Health Review 34(3) 334-339 https://doi.org/10.1071/AH09798
Submitted: 17 June 2009 Accepted: 16 November 2009 Published: 25 August 2010
Abstract
Objective. The Medical Assessment and Planning Unit (MAPU) model provides a multidisciplinary and ‘front end loading’ approach to acute medical care. The objective of this study was to evaluate the impact of a 10-bed MAPU in Royal Melbourne Hospital (RMH) on hospital length of stay.
Methods. A pre-post study design was used. Cases were defined as all general medical patients admitted to the RMH between 1 August 2003 and 31 January 2004. MAPU patients were defined as general medical patients who had been discharged from RMH MAPU unit as part of their RMH inpatient admission. Historical controls were defined as all general medical patients admitted to the RMH between 1 August 2002 and 31 January 2003.
Results. There was a reduction in median length of stay that did not reach statistical significance. During the study period, median emergency department length of stay for MAPU patients was 10.3 h compared with 13.2 h for non-MAPU patients who were admitted directly to general wards.
Conclusions. The reductions in length of stay are likely to be of clinical significance at the emergency department (ED) level. The MAPU model also contributes to providing care appropriate care for older admitted patients.
What is known about the topic? There is increasing interest in models of acute medical management in public hospitals in Australia. One of the key factors driving interest in these models has been the need to improve patient flow to improve hospital efficiency and contribute to reducing bed access block. There are very little published data pertaining to the effectiveness of these models of care.
What does the paper add? The paper reports non-statistical, but probably important clinical reductions in hospital and ED length of stay using a before and after cohort analysis. It highlights the difficulties evaluating these models of care in the absence of well designed controlled studies and suggests evaluation of length of stay needs to be powered to detect small changes in ED efficiency rather than overall hospital length of stay.
What are the implications for practitioners? Practitioners in the area can draw on the results of this paper to design an acute medical planning unit and develop an evaluation framework.
Additional keywords: admission units, assessment units, emergency care.
Acknowledgements
The authors thank Ms Alexandra Gorelik (Clinical Epidemiology & Health Services Evaluation Unit, Melbourne Health) and Associate Professor Ian Scott (Princess Alexandra Hospital, Queensland and Queensland University) for their review of, and comments on, the final draft of the paper.
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