Background: Acute Medical Assessment Units (AMAU) in the United Kingdom, Australia and New Zealand improve inpatient flow and quality. It is critical to spread such best practices. Qatar, a GCC state (Bahrain, Kuwait, Oman, Saudi Arabia, and UAE) has tremendous recent population growth stressing the healthcare system. Hamad General Hospital (HGH), the main national hospital, is a 600 bed tertiary academic medical center accredited by Joint Commission, ACGME and affiliated with Weill Cornell Medical College Qatar. Its Emergency Department (ED) is one of the busiest in the world with nearly half million visits in 2014 and experiences critical blockages in inpatient medicine flow raising concerns about quality.
Methods: In July 2015 an AMAU was established at HGH to improve inpatient medicine flow and quality, initially with 22 then 39 beds, through close collaboration by key stakeholders including leadership, Hospital Medicine, Nursing, Case and Bed Management and support services like Physical Therapy, Diagnostics and Medical Records. It is led by a hospitalist Director with physician and nursing Leads. Medical admissions expected to stay <72 hours are directly admitted. Three Multidisciplinary Teams consisting of a hospitalist, residents, case manager and pharmacist round 7 days a week. Brief “Board” Rounds conducted at 0800, 1130, 1430 and 2130 hours with Nursing, Bed Management and support services ensures rapid, safe, proactive decision making. A physician is available in the unit 24/7/365. A coordinator manages flow. A post-discharge clinic follows pending issues. A Data Dashboard tracks performance indicators.
Results: Over a 3 month period 591 medical patients were admitted to AMAU. Median age is 44 yrs (range=14 – 98 yrs), 74% males, 28% Qataris. Diagnosis included infectious (33%), metabolic (15%) gastrointestinal (13%) and pulmonary (6%) disease. Median length of stay is 2.4 days (range 0 – 16.8 days). 88% were discharged home. 67% and 88% were discharged in <3 days and <5 days respectively. Compared to January 2015, median # daily medical admissions increased from 14.0 to 19.0 (p=0.003) in October and daily discharges from 12.0 to 26.5 (p< 0.001); median # daily pending admissions in ED decreased from 12 to 11 (p =0.55). Median ED waiting time for all admissions decreased possibly partially related to AMAU. 176 patients (30%) were seen in the post-discharge clinic with a 75% show-rate. Majority had a single post-discharge follow-up. Average % Patient satisfaction was 100% for Staff Helpfulness and 91% for Quality of Communication. Anecdotally and in preliminary surveys the MDT team culture has also greatly improved staff satisfaction.
Conclusions: Early results suggest establishing an AMAU improves inpatient medicine flow without affecting quality. To our knowledge, this is the first unit of this kind in the Middle East region.