Acute medicine aims to ensure urgent care to patients with a wide range of medical conditions.

Depending on your hospital, assessment units may be known as:

• Acute Medical Unit (AMU) 
• Acute Medical Assessment Unit (AMAU)
• Medical Assessment Units (MAU)

Patients can be referred directly to an assessment unit by: 

• their GP 
• an Emergency Department 

National Acute Medicine Programme report (PDF, 1.4 MB, 136 pages)

Programme aims

The National Acute Medicine Programme aims to improve the quality and safety of patient care for acute medical patients.

This includes:

• better communication
• safe and high quality care
• timely diagnosis

It aims to do this by:

• making it easier to get the necessary diagnostic tests on time
• cutting down trolley wait times for patients
• promoting a same-day model of care to avoid overnight stays and improve treatment
• reducing hospital stay time when overnight admission is needed

The programme shows the need for senior clinical decision makers to look after acutely ill patients without delay. This leads to a fast investigation, diagnosis and treatment.

It also shows that fair treatment is important for every patient in all services.

The model encourages GPs and community care teams to work together and share their expertise.

Programme objectives

The main goals of the programme are listed below.

Standardised, safe, patient care

Resources will be created and used for the most common acute medical conditions.

These include:

• guidelines
• algorithms 
• care pathways 
• patient information materials

Hospital models

The National Acute Medicine Programme (NAMP) defined 4 hospital models. These explain how acute hospital services work in Ireland.

These models are accepted by the:

• Department of Health
• HSE
• Royal Colleges of Physicians of Ireland (RCPI)
• Irish Association of Directors of Midwifery and Nursing (IADNAM)
• Health Information and Quality Authority (HIQA)
• Therapy Professions Committee

These models provide a clear description of hospital services. They focus on providing safe care while considering the limits of resources, staff and local factors.

In the future, healthcare will grow in areas like same day and ambulatory care and chronic disease.

Because of the new healthcare models and the aging population, local hospitals will need to grow and adapt. This will help them meet a higher demand.

Primary care

Acute medical assessment units based in hospitals will work with GPs, primary care services and community hubs. This will help treat patients with chronic disease.

National Early Warning System (NEWS)

The programme created and implemented:

• the National Clinical Effectiveness Committee (NCEC) (Guideline No.1) National Early Warning Score (NEWS)
• associated communication and handover (iSBAR) protocols

These help to identify when patients are getting sicker. They also provide guidance on how to manage these patients.

Navigation hub/bed bureau and Case Manager (CM)

The programme suggests that acute medical assessment units work better using a navigation hub.

With this hub, Case Managers (CMs) can refer patients directly to the most appropriate care service.

Governance and metrics

The programme sets key:

• accountabilities for the management of assessment units
• measures to monitor their performance and effectiveness

New working practices/continuous presence

The programme suggests improvements to clinical work practises.

This ensures patients get timely care from a senior clinical decision maker and a team of specialists.

New approach to education, training and development

The programme recommends developing acute medicine as a specialty.

It establishes a framework of acute medicine physicians.

These are:

• physicians with acute medicine as their primary specialty
• physicians with a 50/50 acute medicine or other specialty interest

It also recommends establishing acute medicine as a specialty for nursing and therapy professions. 

Acute floor

The model of care first suggested the idea of an acute floor concept in model 3 and 4 hospitals.

The concept was expanded in the Framework for Ambulatory Care on the Acute Floor (PDF, 2.7 MB, 15 pages)

It aims to improve patient care at the time of entry to acute hospitals.

To improve this, it incorporates:

• the Emergency Department
• an Acute Medical Unit
• an Acute Surgical Assessment Unit
• frailty teams and other services

These units and teams work together directing patients to the right care. They also ensure quicker access to senior decision makers.