Acute assessment units closely linked to the Emergency Department and other frontline services will likely be key components of the new Dunedin Hospital.

 

What is an acute assessment unit?

Acute assessment units are at the “front door” of the hospital.

Their role is to assess patients and treat not needing emergency treatment and in doing so to determine whether they require hospital admission or if their needs are better served in enhanced community care.

Patients are seen by a health team comprising, for example, doctors, nurses, physiotherapists and social workers, in one location and ideally problems can be resolved over a short timeframe rather than requiring the patient to be admitted.

Some patients will be referred by GPs who, when their patient’s problem is clear-cut, can bypass the Emergency Department and link the patient quickly and directly with the care they need via the assessment unit.

Why are they needed?

A predicted rise in patient numbers, particularly older patients, will put unsustainable pressure on ED and beds in Dunedin Hospital.

The new hospital will have to meet this challenge through improving patient flows and becoming more efficient.

Many hospitals in New Zealand and overseas have acute assessment units adjacent to ED to improve patient flow and enable early discharge.

Potential benefits
• More appropriate and rapid care for patients – right care, right time, right place.
• Reduction in unnecessary admissions, particularly for older people.
• Better flow of patients through ED.
• More effective discharge planning using a health team approach.
• Better connections with community health providers.
• Improved patient and staff satisfaction with care.

What might acute assessment units look like?

The existing Dunedin already has an acute assessment unit for children, next to the paediatric ward. This unit is open during the day and into the evening but does not provide a 24 hour service.

The adult unit will be bigger and may follow one of several models, including:

1. Acute assessment and planning unit (medical conditions) – MAPU

MAPUs, designed to streamline the assessment of non-critically ill patients, exist in most major New Zealand hospitals. These open 24 hours and are similar to a ward but provide more concentrated care up to a limit of a 48 hour stay.

The Auckland City Hospital MAPU reports that 40% of patients are discharged directly from their MAPU but in some Australian units it has been as high as 80%. The average length of stay for discharged MAPU patients is 23 hours compared to 3.75 days for those admitted as in-patients.

2. Acute assessment unit (surgical conditions) – SAU

SAUs are smaller and less common than MAPUs as most acute surgical assessment happens in ED. SAUs provide more rapid surgical assessment and can identify patients able to be managed by a short stay followed by day-care or community care. A small SAU is currently operating in Dunedin Hospital ED.

 

This Q and A is based on a position paper produced by the New Dunedin Hospital project's Clinical Leadership Group