Abstract
Introduction
The medical intake at Morriston Hospital is accepted on two units; Rapid Assessment Unit (RAU) and Acute Medical Assessment Unit. Both were acute physician-led until July 2021 (Phase 1). From July 2021, RAU became geriatrician-led (Phase 2). This evaluation concerns the performance of RAU.
Phase 1 (Acute Physician-Led Unit)
Between 01/08/2020-30/06/2021, there were 3102 admissions with a median length of stay (LOS) of 2 days on RAU. 37.2% of patients were discharged directly from the unit. (SBUHB data).
A detailed analysis of 496 patients consecutively assessed between November 2020–January 2021 showed a median LOS on RAU of 1, 28.8% were discharged directly from RAU. Overall health board (HB) median LOS for the cohort was 7. In over 70 years, median LOS on RAU was 1, overall HB LOS 9.
Phase 2 (Geriatrician-Led Unit)
1237 patients were assessed July-December 2021, with a median LOS of 2 days. 42.8% of patients were discharged from RAU. (SBUHB data).
A detailed analysis of 566 patients consecutively assessed between September-November 2021 showed a median LOS on RAU of 2, 41.7% discharged directly from RAU. Overall HB median LOS for the entire cohort was 5. For the > 70 years, median LOS on RAU was 2, overall HB LOS was 7.
Patient flow through assessment areas is dependent on the function of downstream medical wards. Mean LOS within medicine at Morriston increased 1.5 days between Phase 1 and Phase 2.
Results
Acute geriatricians have delivered the 72hr LOS standard that SBUHB has set for assessment areas.
The unit has achieved a reduction in overall LOS for the cohort of patients evaluated (p<.01), especially for the > 70 years (p=.007).
This data supported a change in practice; RAU has taken a frailty specific intake since January 2022.
Comments
Excellent work, glad to see early geriatrician review on the acute take. How does the streaming between RAU and MAU work and when is that decision made? For the frailty specific intake, do you have a specific Rockwood CFS cutoff or is chronological age a factor?
Thanks for commenting! Both RAU and AMAU accept patients directly from ED. The decisions were made by bed managers whilst patients in ED, guided by post-take medical consultants' plan. Both units are separated geographically. Since RAU became geriatrician-led, we had access to admit patients from our front door frailty service in ED (OPAS) directly to RAU if they needed to be admitted for a short stay 24-72 hours. Otherwise, patients were admitted to ED and RAU as per the usual bed management process previously until the unit set a frailty specific criteria - patients >70 years, presented with frailty syndromes and/or from nursing or residential home. These are the same criteria used for our front door frailty service in ED (OPAS).
We have since analysed patients admitted to RAU following the frailty specific criteria set for the unit - we presented this at the BGS Wales Meeting last month. Unfortunately, 50.1% of patients did not meet the frailty criteria set for the unit. This is likely due to increased pressure in the hospital etc. There's still a lot of work to be done..