Medical Assessment Units in NSW

Background

Medical Assessment Units (MAUs) were originally established in NSW in 2008. They were developed in conjunction with the Physicians Taskforce and Acute Care Taskforce to deliver faster, safer better care for the elderly and those with chronic conditions and as an alternative to treatment in the Emergency Department (ED).

In 2012 the then NSW Department of Health undertook an evaluation of the 29 MAU across the state. The evaluation report, published in 2013, recommended that:

ACI will undertake a broader consultation of the Medical Assessment Unit Model of Care 2012 to ensure the components are achievable across existing and future MAU.

ACI subsequently convened a MAU Model of Care Working Group and undertook an extensive consultation process. In 2014 an updated model of care was published. Resources to support implementation of the MAU Model of Care include:

• MAU Model of Care
• MAU Model of Care FAQ
• MAU Self-Assessment Tool (for Excel version 2010 and newer)
• MAU Self-Assessment Tool (for Excel version 2007 and older)

What are Medical Assessment Units (MAUs)?

MAU in NSW are inpatient short stay units that are usually close to or co-located with an Emergency Department (ED). A MAU is specifically designed to improve the coordination and quality of care for patients, increase efficiency in inpatient management and ultimately, assist with improving patient flow across the hospital. The difference between a MAU and an inpatient unit is that the MAU always feature a dedicated interdisciplinary team led by consultants.

The model recommends that the staffing for a MAU includes a:

• Medical Director, ideally a General Medical staff specialist for senior decision making
• Medical staff, ideally Monday to Sunday, 8-10pm
• Nursing Unit Manager; this is dependent on the size of unit
• Supernumerary Care Coordinator
• Nursing staff for direct patient care, ideally 1:4 ratio
• Access to a Clinical Nurse Educator
• Team lead for allied health and dedicated pharmacy, physiotherapy, social work and occupational therapy, ideally with a 7 day per week coverage. Plus established access to speech pathology and dietitans.

Ideally, a General Practitioner should also form part of the MAU team.

A typical patient suitable for management under the MAU Model of Care is an adult with an acute undifferentiated presentation who may:

• have a history of chronic and/or complex condition(s); and/or
• have an exacerbation caused by an issue in the their social environment, e.g. carer absent, overcrowding within the home; and/or
• be on a pathway for rapid assessment e.g. chronic back pain.

Potential benefits of a Medical Assessment Unit

Demonstrated international evidence exists for a MAU co-located with ED with a model of care under general medicine include¹:

• a significant reduction in inpatient mortality (between 0.6%-5.6%)
• a significant reduction in the length of stay (between 1.5 and 2.5 days)
• a significant reduction in waiting times for patient transfer from EDs to medical beds (up to 30%)
• no increase in 30-day readmission rates following unit commencement
• improvements in patient and staff satisfaction with care.

These documented benefits are plausibly generalisable to the NSW setting. It is also proposed that the NSWMAU Model of Care can deliver additional benefits such as:

• improved population health outcomes through a more coordinated management of comorbidities
• an improvement in community capability to care for patients
• an improved patient experience through a dedicated interdisciplinary and more integrated approach to providing patient care
• health system efficiencies and lower costs through:
  • a reduction in undifferentiated, complex, non-critical medical patients presenting to the ED by providing direct referral to the MAU
  • an improvement in a facility’s ability to manage acute demand and the flow of patients, resulting in an enhanced capability to meet national and state targets
  • a reduced level of intensive investigations prior to decision-making
  • reduced number of patient outliers on inpatient wards
  • a reduction in readmissions due to improved coordination and early activation of community care for those patients discharged home

  ^{1. Scott I, Vaughan L, Bell D. Effectiveness of acute medical units in hospitals: a systematic review. Int J Qual Health Care. 2009;21(6):397-407}