Acute Medicine National Clinical Programme
The National Acute Medicine Programme was established in 2010 to standardise and improve the management of acutely ill medical patients in the Irish Healthcare system. Acute medicine is concerned with the immediate and early specialist management of adult patients suffering from a wide range of medical conditions who present to, or from within an acute hospital and require urgent or emergency care. Acute medical units (AMUs), acute medical assessment units (AMAUs), and medical assessment units (MAUs) have been developed to support the delivery of this care. The seminal report on The National Acute Medicine Programme was published in December 2010.
The overarching aims of the National Acute Medicine Programme are to ensure that all acute medical patients have a better patient experience with improved communication receiving safe, quality care with timely diagnosis and the correct treatment delivered in an appropriate environment. The aim of the programme is to improve the quality and safety of patient care by increasing access to timely diagnostic tests and eliminate trolley waits for medical patients, reduce cost and increase value by promoting an ambulatory model of care and shorten average length of stay for admitted patients. The programme emphasises the fundamental importance of allowing senior clinical decision makers to assess acutely ill patients without delay to initiate rapid investigation, diagnosis and treatment, and the concept of Clinical Justice. An important focus of the model is the close collaboration and interdisciplinary working with GPs and community care colleagues.
The key objectives of the programme include:
Providing standardised, safe, patient care: Detailed guidelines, algorithms, care pathways and patient information materials will be developed and implemented for the most common acute medical presentations.
Hospital models: The NAMP defined the four hospital models now used to describe the basic functionality of acute hospital activity in Ireland, and accepted by the Department of Health, Health Services Executive, Royal Colleges, Hospital Information and Quality Authority (HIQA). The purpose of these models is to provide a clear delineation of hospital services based upon the safe provision of patient care with the constraints of available facilities, human resources and local factors. The future growth in healthcare will be in the areas of ambulatory care and chronic disease management. As a result of these emerging models of healthcare delivery and the ageing population, the total volume of activity in local hospitals will grow substantially for the successful implementation of this programme.
Primary care: General Practitioners (GPs) will be supported by their hospital colleagues and specialized nurses in the provision of chronic disease management in primary care.
Acute medical units: (AMUs), acute medical assessment units (AMAUs) and medical assessment units (MAUs): the programme defines these different types of assessment units, how they should be led, operated and resourced and how they differ per hospital model. Some model 4 hospitals may have a Medical Short Stay Unit (MSSU) to assist in the clinical management of patients requiring a 1-2 day admission under the governance of Acute Physicians.
National Early Warning System (NEWS): the programme developed and implemented the NCEC (Guideline No.1) National Early Warning Score (NEWS) and associated communication and handover (iSBAR) protocols to enable early identification of deterioration in patients and how they should be best managed. The NECE (guideline No.1) was revised in 2020 by the DPIP Programme and renamed to Irish National Early System (INEWS).
Navigation hub/bed bureau and case manager (CM): the programme advises that acute medical services are best delivered utilising a navigation hub concept where case managers (CMs) are able to stream patients referred by GPs and other services to the most appropriate pathways of care and back into the community or residential setting again following treatment and discharge.
Governance and metrics: the programme sets key accountabilities for the management of assessment units and key measures to monitor their performance and effectiveness and so enable continuous improvement.
New working practices/continuous presence: the programme sets out recommended enhancements to clinical work practices in order to ensure patients receive timely care from a senior clinical decision-maker working within a dedicated multidisciplinary team.
New approach to education, training and development: the programme recommends the development of acute medicine as a specialty and the establishment of a cadre of acute medicine physicians (i.e. physicians with acute medicine as their primary specialty and physicians with a 50/50 acute medicine/other specialty interest. The programme also recommends the development of acute medicine as a specialty for nursing and therapy professions.
Acute floor: the model of care first muted the idea of the development of an Acute Floor concept (in model 3 and 4 hospitals) for the efficient streaming and management at the front door of Acute Hospitals which incorporates the Emergency Department, Acute Medical Unit & Acute Surgical Assessment Unit, Frailty teams and other services working in tandem with immediate streaming and access to senior relevant decision makers at the earliest opportunity. ‘The Acute Floor Model for Ireland’ was published in 2017 (H.S.E.) and has shown significant progression of this concept. Further development of the Model is part of the HSE National Service Plan for 2019, and is contained within the SlainteCare implementation plan (Department of Health 2018).