INVESTNET
PROJECT
New Care Pathway to Enable Ambulances Transfer Patients to a Model 2 Hospital Medical Assessment Unit (MAU)
TEAM:
Ms Claire Crowley, Hospital Manager, MGH; Ms Patricia Moloney, Director of Nursing, MGH; Dr Anne Marie O’Flynn, Consultant, MGH.; Dr Ceara Hart, Consultant, MGH; Dr Adelina Munoz Claros, Consultant, MGH; Dr Daniel Schmidt, Consultant, MGH; Dr John Kiely, Consultant, MGH; Ms Siobhan Daly, CNM MAU, MGH; Prof Cathal O’Donnell, Clinical Director, NAS; Mr Darryl Coen, NAS; Mr Barry Hayes, NAS; Prof Conor Deasy, Consultant and Clinical Director Emergency and Acute Care, CUH.
LOCATION:
Mallow General Hospital
THE PROBLEM:
Mallow General Hospital (MGH) was designated a model 2 centre following reconfiguration of the acute hospital sector. As a result, the Emergency Department (ED) in MGH was replaced with a Local Injuries Unit and Medical Assessment Unit (MAU). Patients are traditionally seen in the MAU following referral by their GP. Ambulance bypass protocols had been in place for emergency 999 or 112 calls. It was recognised that many patients being transferred to already overcrowded model 3 or 4 centre EDs could be managed in a model 2 centre MAU. In collaboration with colleagues in the National Ambulance Service (NAS), we developed a pathway whereby certain patients from the North Cork catchment area, for whom a 999 or 112 emergency call had been made, could be brought directly to the MAU in MGH. The aim of this project was to assess the feasibility, safety and effectiveness of this pathway over a 3-month pilot period.
THE SOLUTION:
We implemented the Plan-Do-Study-Act (PDSA) cycle for this project. Strict inclusion and exclusion criteria were agreed. A discussion took place between the paramedic assessing the patient and the medical consultant covering the MAU. A purpose specific free-phone number was established so ambulance personnel could contact MGH directly. They spoke to the medical consultant on call using the ASHICE handover framework to discuss the patient. The decision to transfer to the MAU was made by the medical consultant. The pathway operated Monday to Friday from 8am to 6pm. The NAS provided training to paramedic staff prior to formal implementation of the pathway on the 1st of September 2022 for a 3-month pilot period.
BENEFITS:
Implementation of this pathway safely facilitated the assessment and treatment of patients in an appropriate setting close to their home. Of 39 patients discussed over the 3-month period, 29 were accepted to the MAU. One patient declined transfer. Seven patients were discharged on the day they were reviewed. Twenty patients were admitted to MGH. One patient required same day transfer to a model 4 centre following review. The mean age of those reviewed was 73 years. The mean length of stay for those admitted was 8 days. We estimate that for each patient accepted to the MAU approximately 150 minutes of ambulance time was returned to the system. Therefore approximately 72.5 hours of ambulance time was saved over the 3-month period of this project.
PROJECT CONTACT DETAILS:
Dr Anne Marie O’Flynn, Clinical Lead, Mallow General Hospital.