Quality statement 2: Assessment and initial treatment through acute medical units

Quality statement

Adults who are admitted with undifferentiated medical emergencies are assessed and initially treated in an acute medical unit (AMU).

Rationale

An AMU provides rapid assessment, investigation and treatment for medical emergencies, which are often undifferentiated and may involve multiple medical pathologies. When there is clear pathology and a clear pathway (for example, for treatment of specific conditions such as an acute heart attack or acute stroke), AMU admission may not be appropriate. Assessment in an AMU can reduce mortality rates and length of stay.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults who are admitted with undifferentiated medical emergencies have an assessment and initial treatment in an AMU.

Data source: Local data collection, for example clinical protocols and agreed pathways.

Process

Proportion of hospital admissions for undifferentiated medical emergencies who were admitted to an AMU.

Numerator – the number in the denominator who are admitted to an AMU.

Denominator – the number of hospital admissions of adults for undifferentiated medical emergencies.

Data source: Local data collection, for example audit of electronic case records.

Outcomes

a) Hospital mortality rates for adults admitted to hospital for undifferentiated medical emergencies.

Data source: Local data collection, for example audit of electronic case records.

b) Length of hospital stay for adults admitted with undifferentiated medical emergencies.

Data source: Local data collection, for example audit of electronic case records.

What the quality statement means for different audiences

Service providers (such as emergency departments, urgent care centres, primary care and ambulance services) ensure that locally agreed referral pathways are in place for adults who are admitted with undifferentiated medical emergencies to have an assessment and initial treatment in an AMU. Service providers also ensure that staff are aware that when there is clear pathology and a clear pathway (for example, for resuscitation or treatment of specific conditions such as a heart attack), AMU admission may not be appropriate.

Healthcare professionals (such as acute physician-led multidisciplinary AMU teams) carry out an assessment and initial treatment in an AMU for adults who have been admitted with undifferentiated medical emergencies. The timescale of this assessment and the need for initial treatment is based on the person's condition.

Commissioners (clinical commissioning groups) ensure that they commission AMUs with sufficient resources and expertise to carry out assessments and initial treatment for adults who have been admitted with undifferentiated medical emergencies.

Adults who are in hospital with a medical emergency that has no exact known cause have an assessment and their initial treatment in an acute medical unit.

Source guidance

Emergency and acute medical care in over 16s: service delivery and organisation (2018) NICE guideline NG94, recommendation 1.2.2

Definitions of terms used in this quality statement

Undifferentiated medical emergencies

Acute medical conditions with no exact known cause and no clear, predetermined clinical pathway, and for which hospital assessment is deemed necessary.

[Expert opinion]

Acute medical unit

An acute medical unit (AMU; also called an acute assessment unit [AAU] or medical admissions unit [MAU]) is an area of an acute hospital where people with undifferentiated medical emergencies who need hospital admission receive rapid assessment, investigation, initial treatment and definitive management. Referral to AMUs is based on locally agreed referral pathways.

[Adapted from the evidence review on assessment through acute medical units for NICE's guideline on emergency and acute medical care in over 16s: service delivery and organisation, and expert opinion]