An Assessment and Planning Unit reduces length of stay in hospital for General Medical patients

The Assessment and Planning Unit (APU) at Royal Hobart Hospital (RHH) was opened in July 2012. The 11-bed unit is staffed and equipped to receive general medical patients from the Emergency Department (ED) for observation,and treatment prior to transfer to a medical ward or discharge. The APU concentrates patient assessment, planning and management in the first part of the patient’s hospital journey. The hypothesis is that this focus of resources during the early part of a patient’s journey will reduce overall length of stay (LOS) for this patient group.

We tested this hypothesis by comparing LOS between general medical patients admitted from the ED to the APU and general medical patients admitted from the ED to other wards at RHH over a 6-month period. A patient’s destination from ED is largely determined by bed availability.

The general characteristics of patients journeying through APU or directly to other wards were compared by examining age, DRG mix, comorbidities, mode of separation, place of residence, and number of admissions in the previous year. There were few significant differences between the two groups: APU patients were slightly older on average (3 years, p=0.007); more APU patients were discharged to aged care facilities (p=0.05); and chest pain was more common as the discharge diagnosis among APU patients (p=0.03).

We then built a model of LOS as a function of these variables, to control for differences between the two cohorts of patients. Adding destination ward (APU versus other) to the final model, LOS was reduced by 19% (e.g. by a day for an average 5-day LOS) for patients journeying through APU (95% confidence interval 12%–25%) compared to other patients, while controlling for other variables.

In summary, there is strong evidence that the APU model of care reduces the length of patients’ hospital stays.