title: Did an acute medical assessment unit improve the initial assessment and treatment of community acquired pneumonia--a retrospective audit.
abstract: OBJECTIVE
  Medical Assessment and Planning Units (MAPUs) are proposed as a means to treat medically unwell patients in a timely and clinically appropriate manner, thus improving quality, facilitating safe early discharge, and reducing congestion in emergency departments. This study assessed the impact of opening a MAPU on the initial assessment and treatment of patients with community-acquired pneumonia (CAP).
  
  
  METHODS
  A retrospective audit of patients presenting to Wellington Hospital was conducted from January to March 2009 and January to March 2010, straddling the opening of a MAPU. Outcome measures included timeliness of assessment, indicators of clinical quality, length of stay, recommended follow-up and mortality.
  
  
  RESULTS
  MAPU referred patients were less unwell and younger. Times to first doctor assessment and X-ray were longer than in the Emergency Department (ED) following the introduction of the MAPU; time to physician review for all admitted patients was unchanged compared to before the opening of the MAPU. Compliance with other aspects of evidence based guidelines was patchy and showed no improvement following the opening of the MAPU. Most patients whose length of stay was short were appropriately admitted to the MAPU.
  
  
  CONCLUSIONS
  The MAPU has successfully streamed a cohort of less unwell patients away from the ED. Opportunity exists to improve the timeliness of treatment and compliance with guidelines. A disease-specific audit has served as a useful adjunct to other approaches to assessing a unit's impact.
authors.affiliation: Capital and Coast District Health Board, Wellington, New Zealand. David.Tripp@xtra.co.nz
authors.forename: David G
authors.initials: DG
authors.lastname: Tripp
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand; D010346:Patient Care Management / Q000592:standards*; D011014:Pneumonia / Q000175:diagnosis / Q000628:therapy*; D011787:Quality of Health Care; D012189:Retrospective Studies