Medical Assessment Units and the older patient: a retrospective case-control study

Abstract

Eighty-nine patients were studied; 47 in the MAU group and 42 in the non-MAU group. The MAU cohort was significantly older (84.1 ± 7.9 years v. 80.4 ± 7.8 years, respectively, P=0.03); and had shorter ED LOS (4.9 ± 3.0h v. 6.5 ± 2.8h, P=0.012). Overall hospital LOS did not differ except for patients with 'cellulitis', (5.7 ± 4.9 days for MAU cohort v. 14.8 ± 6.8 days for non-MAU cohort, P=0.022). There was no significant difference in mortality, readmission rate or discharge destination. Conclusions. The MAU can be an effective service model for older patients. More research is required to confirm this and to define the key elements that are essential for its effectiveness.

The emergency department prediction of disposition (EPOD) study

“…11 Observation wards and short-stay units have added new streaming options for ED patients who require a short period of admission for clinical observation and intervention. 2 ED short-stay units have traditionally been reserved for patients who are most likely to be discharged within 24 h. Medical admission and assessment units have become commonplace in many hospitals as a conduit for medical admissions from the ED 3,4 .…”

Interventions targeting the elderly population to reduce emergency department utilisation: a literature review

“…Of them, only five studies demonstrated statistical significance in lowering ED use or ED length of stay (LOS) 27 31 32 36 37. None of them used RCTs.…”

“…Two of the five interventions featured multidisciplinary team and care planning,36 37 and another two interventions included follow-up visits 31 32. However, unlike community-based interventions, these hospital-based strategies were most characterised by risk screening and geriatric assessment for the purpose of identifying potential risk factors and unresolved problems,27 32 36 37 and discharge planning and referral coordination 31 32. Most of the interventions were relatively long-term, with only two being shorter than 6 months.…”

“…Five studies were available only as abstracts, which limited assessment of quality and were thus not appraised against the EPHPP tool 16 22 25 26 30. Of the 31 studies assessed, four were appraised as strong,7 12 13 39 17 were rated as moderate,8–10 15 17 19–21 23 24 28 29 31 34 35 38 42 and 10 were of weak quality 11 13 18 27 32 33 36 37 40 41. Blinding, Selection bias, Confounders, and Data Collection Methods are the most problematic methodological components that result in the weak and low quality of these studies.…”

What is the evidence for the management of patients along the pathway from the emergency department to acute admission to reduce unplanned attendance and admission? An evidence synthesis

“…GP admissions not targeted through GPSU increased by 3.99 per day (2.64 to 5.33). Modest reduction in GP admissions to MAU but no reduction in number of GP admissions to hospital wards.Before and after design.Ong et al, 2012, Australia [13]Patients ≥65 years. Diagnosis groups: falls and gait disorder, COPD, other major respiratory diseases, cellulitis.…”