Patient Flow

Improving Acute Medical Units

How can we design a strategy to ensure that patients are discharged from Acute Medical Units (AMUs) at the right time, by the right people?

With increasing pressures on both staff and space in hospitals, there are now questions surrounding the future role of the Acute Medical Unit (AMU). The AMU is a specialised unit in major hospitals that a patient enters via a GP referral or through A&E. Staff at the AMU have less than 72 hours in which to diagnose and establish the correct course of treatment. The AMU is important within a hospital because it helps to alleviate the pressure on the rest of the units – but this can only work well if the process is efficiently managed. The Royal College of Physicians of Edinburgh, in partnership with the Helen Hamlyn Centre for Design, have been keen to look at how design might help improve the situation in these units. ‘Patient Flow’ started in October 2013 as a project to address this.

As the system currently stands, there are various areas that become problematic when trying to maintain a good flow of patients through the AMU. Repetitions and duplications of tests often occur, and are sometimes even overlooked. This happens because there are many members of the team, but they do not have an efficient way of reporting and communicating their decisions to the rest of the team. As a department, it is incredibly well resourced and the staff provide a unique standard of attention and treatment, but there are still areas for improvement within the process.

Laís de Almeida conducted research across a total of nine UK hospital sites looking at which areas are under significant pressure in hospitals. One of the biggest challenges facing AMU staff is communication, vital for giving the team a better overview of a patient’s treatment. The biggest insight is that because the medical team try to rule out the causes of the symptoms with a process of elimination, the investigative process is not linear but iterative. This makes it difficult to have an overview of the patient’s AMU journey.  Clearer and more streamlined communication is at the heart of the design challenge.

The aim of the project is to bring more visibility to the patient’s care journey, so that both patients and staff know what is happening and what needs to be done. It means that jobs could be better coordinated and planned; a nurse would be able to see if something is missing, or if a patient knows they can go home soon, they will be able to arrange transport. Creating a digital tool that allows for information to be shared in a more visual way, and that aggregates information from the other databases in the hospital, creates a visual pathway of the patient’s care journey, from admission to discharge.

Analogue and Digital
As many hospitals do not use advanced digital tools yet, the project created an analogue version of this system to replace the existing whiteboards often used in staff offices. Although the analogue version will be much more simple, and without the depth of information, it is meant to be a stepping-stone towards the digital system. It is also important to keep the patient informed as much as possible during their hospital stay, so that they understand that there is an iterative cycle to finding out what the problem is. Daily updates on their progress will show them how the medical staff is trying to help, eventually forming a booklet of information. Ideally, this information would help the patient with planning further help when they are released from the AMU. The patient booklet is of the hospitals Laís has been working with, and it is hoped that by September 2016, the first prototypes of both the digital and analogue systems will be ready for testing.

See previous year's project

Research Associate:
Laís de Almeida

Senior Research Associate: 
Gianpaolo Fusari

Healthcare Research Leader:
Jonathan West

Research Partner:
Royal College of Physicians of Edinburgh (RCPE)