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

Abstract

Objective. To evaluate the effect of a Medical Assessment Unit (MAU) on older patients. Methods. Retrospective case-control study of patients 65 years and above admitted to the MAU (study group) and the general medical wards (control group) in Bankstown-Lidcombe Hospital from 1 October 2008 to 31 March 2009 with four most common Diagnosis-Related Groups (DRG) (‘falls and gait disorder’, ‘chronic obstructive pulmonary disease (COPD)’, ‘other major respiratory diseases and ‘cellulitis’). Main outcome measures. Length of stay (LOS) in Emergency Department (ED) and in the hospital, mortality, readmissions within 1 month, and discharge destination. Results. 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 ± 3.0 h v. 6.5 ± 2.8 h, 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. What is known about the topic? The Medical Assessment Unit is a model of care that has been developed in response to increasing Emergency Department presentations and rising demand on hospital beds. There has been some evidence that this model of care improves efficiency by reducing Emergency Department length of stay and overall hospital length of stay, but little published data targeting the Aged Care population group, who account for a high proportion of Emergency Department admissions. What does this paper add? This paper is a case-control study and provides additional evidence on the benefit of the Medical Assessment Unit model in the elderly population, specifically the benefits in the reduction of Emergency Department length of stay and overall hospital length of stay. This paper also assists in identifying key elements essential for the success of the Medical Assessment Unit model. What are the implications for practitioners? With increasing demand on healthcare, practitioners need to continually redesign how they deliver healthcare to maximise cost efficiency and effectiveness. We believe the Medical Assessment Unit is an effective new model of care. However, more research is required to further refine this model and also identify target patient groups who can most benefit from this model of care.