Managing acute medical admissions: a survey of acute medical services and medical assessment and planning units in New Zealand

Authors


  • Funding: None.

  • Conflict of interest: John Gommans is currently Vice President (NZ) of IMSANZ and Andrew Burns is an IMSANZ council member and a member of the RACP Specialist Advisory Committee (NZ) for advanced physician training in General and Acute Care Medicine.

John Gommans, Hawke's Bay Hospital, Private Bag 9014, Hastings, New Zealand. Email: john.gommans@hawkesbaydhb.govt.nz

Abstract

Aims:  To determine the current provision of acute medical services, including the development of medical assessment and planning units (MAPUs), by district health boards (DHBs) throughout New Zealand (NZ).

Methods:  A questionnaire-based survey about organisation of acute medical services and establishment of MAPUs was sent to all 21 DHBs in NZ.

Results:  All 21 DHBs responded. Seven DHBs serving 42% of the population have established MAPUs since 2003 and a further six have plans to do so over the next 3 years, potentially expanding service to 73% of the NZ population. All seven current MAPUs are in close proximity to and accept patients directly from emergency departments. Each MAPU has a documented target length of stay, four units have referral protocols, five provide guidelines for management of common medical emergencies and five routinely audit unit performance. Five MAPUs have cardiac monitored beds and isolation rooms. Rapid access is available to computed tomography scanning (six units), ultrasound (five) and echocardiography (four). Two units have no nominated physician leadership and two lack dedicated therapy resources. General physicians are involved in provision of acute medical services in 20 of 21 DHBs.

Conclusions:  Medical assessment and planning units have become an important component of acute medical service provision in NZ. The established units largely comply with Australasian recommendations, although important deficiencies exist. Training of physicians must combine the needs of acute medical patients and clinical roles of physicians within MAPUs with local DHB requirements for services to be most effective.

Ancillary