EMUs and decision making
Emergency Multidisciplinary Units are day-units treating older patients with complex medical and social needs, without keeping them in a hospital bed overnight, so-called ‘Ambulatory Care’.
The EMUs are based in local community hospitals, allowing patients to be treated closer to their home. During a visit to an EMU, patients are treated by a multidisciplinary team made of a doctor, nurse, physiotherapist, occupational therapist and social worker. This allows each person to be assessed as a whole and a personalised treatment plan made.
Medical care at the EMU is different to a normal hospital visit because patients are treated in the day and return to their homes overnight, which they and their carers often prefer. This also frees up resources and beds in acute hospitals.
However, as patients are at home overnight, they are away from their care team between their treatments. It is therefore vital for their safety that the correct decisions are made about which patients are suitable for ambulatory care, and which may need to be treated in a hospital bed overnight.
Doctors and nurses need to be able to judge who would be suitable for this type of medical care. Making sure that staff are properly trained to be able to undertake this complex work is vital for both patient safety and the future of the EMUs.
The CLAHRC and its host trust, Oxford Health NHS Foundation Trust, have developed a new ‘researcher in residence’ (RiR) role at the EMU.
The RiR, Dr McKelvie, is a clinician (GP) themself, working in partnership with the multidisciplinary team at the frontline of EMU care delivery.
Alongside their clinical duties, with support from the CLAHRC, the RiR investigates clinical decision making in EMUs across three Oxfordshire sites, observing and interviewing clinicians at work and patients using a case study approach, to see the factors that influence their decision-making behaviours.
The information gained from this work will be used to improve training for doctors and nurses working in ambulatory care centres, such as the EMU.
The King’s Fund estimates that 1 in 6 emergency medical admissions could have been treated without the need of a hospital bed overnight in an acute hospital, and estimates that between £96-238 million could be saved by reducing these hospital admissions.
Developing training based on this work to help ensure that the right decisions about which patients are suitable for ambulatory care models it is a key step in realising these savings.
…I am surprised at the profound effect it [working at the EMU] has had on my personal and professional development. I have been lucky enough to be able to continue my work at the EMU as ‘Researcher in Residence’…
- Dr Sara McKelvie.
The project is ongoing at the time of writing but has already shown that an RiR post can play a key role in clinical teams, helping to support clinical audit and quality improvement work, and promoting research within the EMU teams.
This role has shown how an individual with skills from General Practice, with training and support from the NIHR CLAHRC Oxford, can help lead change and support quality improvement at Oxford Health NHS Foundation Trust and promote academic primary care.
At the end of the project, once the data has been analysed, it is planned to host a conference style day where local and national stakeholders from academic, clinical and educational fields participate in a series of workshops to discuss the key findings.
This will also help inform how to best train and support the future workforce in ambulatory care as well as address any barriers to staff recruitment and retention in these new models of care.