The Medical Assessment Unit (MAU) at Osler is an 8 bed short-stay (up to 48 hours) inpatient unit located near each of our Emergency Departments (ED). Opened in 2010, this unit is staffed by an RN, RPN and an allied health team made up of a social worker, CCAC case manager, Geriatric Emergency Medicine RN (and others) that provides structured care to patients through ten pre-printed order sets that represent the top reasons for admission. A MAU physician and a nurse practitioner conduct increased patient rounding and this along with a culture devoted to early discharge planning, a target length of stay (LOS) of 48 hours and direct referrals (patients go straight to the unit and do not wait for the MAU physician to consult the patient first) from the ED physicians make this a unique model of care. This increased rounding has proven to have high patient & family satisfaction, with a low complaint rate and strong positive feedback through our discharge surveys. The organization was challenged by many admitted patients boarded in the ED. After careful data analysis, it was determined that there was a large portion of medicine inpatients with a LOS of 72 hours or less. These shorter stay patients were often less acute and typically represented ten diagnoses such as asthma, dehydration, pneumonia. The measurable objectives targeted in the evaluation of the MAU were: • Improved accessibility • Improved efficiency • Improved patient satisfaction. The results of the evaluation demonstrated that patients wait a fraction of the time in Emergency to get to this unit versus all other units in the hospital (example at EGH, 90th percentile ‘Time to Inpatient bed’ was reported at 2.39 hours vs 34.5 hours). • Improved LOS: The average length of stay for the top 3 diagnosis admitted to MAU (abdominal pain, overdose, gastroenteritis) is 1.1 days compared to 2.6 days prior to opening the MAU. This translates to a 58% improvement in LOS and only less than 1% of patients stay in the MAU beyond 48 hours in the MAU. Over 92% would definitely/probably recommend this unit to family or friends. By focusing on these patients and improving their LOS, we would be able to reduce the number of admitted patients in the ED. In addition, we wanted to create a model that really focused on the patient and was not provider-driven.

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