At the nurses station in the Medical Assessment Unit are, from left: Noreen Hough, Assistant Director of Nursing, Nenagh Hospital; Staff Nurse Majella Bourke; Staff Nurse Aine Gleeson; Staff Nurse Pat
A €650,000 makeover at Nenagh Hospital is making a positive impact on services to patients and workflow for staff, enabling more efficient throughput of patients as well as a safer and more accessible care environment for all.
The hospital's Medical Assessment Unit (MAU), which initially opened on the first floor of Nenagh Hospital in 2009, has since May relocated to a modern facility on the ground floor of the hospital. The new MAU is situated within close access to all the diagnostics that may be required by patients assessed in the unit.
MAUs facilitate the assessment, diagnosis and treatment of patients with medical conditions such as chest infections, chronic obstructive pulmonary disease (COPD), pneumonia, urinary tract infections, fainting episodes, clots in the leg, anaemia and non-acute cardiac problems. The units are for patients who do not require admission, but who do need assessment, investigation and a treatment plan, and, in some cases, a follow-up review after a few days.
The relocated unit means that patients have greater access than ever before to the service.
With a development cost of approximately €650,000, the new unit includes seven assessment spaces, of which three are isolation rooms. There is also a seating area for six patients, and the entire facility is within full view of the nurses’ station in the unit.
Staffing the unit is a clinical nurse manager among a complement of four nurses, as well as a registrar, SHO and consultant.
Catherine Quinn, a CNM2 who works between the MAU and the adjoining Injury Unit, explained that one of the most significant impacts of the new unit had been the increased daily patient assessments because of the facility’s dedicated seating area.
“We use the Fit to Sit initiative, so patients who are fit to sit will be able to wait in that waiting area rather than waiting on a trolley for the assessment, as the full assessment and investigation can take from four to six hours. We were never able to do that in the old unit, and this seating area is one of the things that we wanted to incorporate in the design for the refurbished unit,” she said.
Due to the improvements, the number of patients using the service has increased. On Mondays through Wednesdays, the MAU staff will assess 14 new patients per day (with up to an additional four review cases daily). On Thursdays, 12 patients will be assessed, and 10 on Friday.
The increased throughput is targeted because MAUs are appointment-based. Patients are pre-assessed by a GP or ShannonDoc out-of-hours service, or the Emergency Department at University Hospital Limerick, and referred, via the UL Hospital Group’s Bed Bureau, for assessment in the MAU.
Catherine described the assessment process as “very thorough, but targeted”.
“Patients will have been pre-assessed, of course, and when they come in here, they will be seen by nursing, by a doctor, and reviewed by a consultant, as well as being provided with a plan of care before they go home," she said.
The MAU staff has access to four CT brain scans per day, two doppler ultrasounds per daily, and unlimited X-Ray. The MAU also has an outpatient referral pathway to cardiac diagnostics for holter and blood pressure monitors as well as echograms and stress tests.
For the staff of Nenagh Hospital, the refurbished unit has allowed for more efficient operations.
“We have a much better flow of patients now,” Catherine said. “Patients will check in at reception and the receptionist will bring them to the unit, where they take a seat in the seating area. The nurse will then bring the patient up to the trolley for the initial assessment. If they are fit to sit, they will sit out and wait for the next phase. The doctor brings them either to a trolley or to an isolation room, and after assessment, orders whatever tests might be required. After these diagnostics, they will wait in the seating area, and the consultant will see them once the results are available.”
Assistant director of nursing at Nenagh Hospital, Noreen Hough, said: “The unit used to be situated upstairs, and at the furthest end possible. Many of the patients coming to the unit would be presenting with respiratory infections, chest conditions, breathing problems. So they had to go upstairs, and porters would be required to convey them for diagnostics at the far end of the hospital. Obviously, the facilities and equipment are right up to date, but the most significant improvement is accessibility and safety, for patients and for staff.”
Patients attending the MAU at Nenagh Hospital also have access to social workers, occupational therapists and dieticians appointed to the hospital, as well as access to physiotherapy, a service that is always in demand in a unit where patients are presenting with injuries from falls or difficulties around mobility.
“We are always looking at new possibilities, things that would never have been imaginable in the old MAU, and it’s this efficiency of service that is probably the most crucial aspect of the refurbished unit,” Catherine said.