National Acute Medicine Programme--improving the care of all medical patients in Ireland.
BACKGROUND
The National Acute Medicine Programme (NAMP) was established to address the unsatisfactory management of acutely ill medical patients in Ireland. It aimed to improve quality of care and patient safety, streamline access to healthcare, and reduce cost through efficiency gains.


METHODS
A model of care was developed to describe 4 distinct clinical pathways for medical patients streamed through acute medical assessment units. A patient flow model was used to build system capacity and predict demand for each hospital. Specific practice changes necessary were identified for each pathway. A performance framework, with national benchmarks that mirrored the model of care, was also developed. The program team met regularly with hospitals and fed back performance information and, using appreciative enquiry, supported local improvement plans.


RESULTS
Thirty-two out of 33 Irish hospitals that admit acute medical patients are now operating the program. Process improvement lies at the core of all the success achieved by the program. Available inpatient data were improved and harnessed to support ongoing audit and quality improvement. A reduction of 1.6 days in average length of stay nationally was achieved between 2010 and 2013.


CONCLUSIONS
Despite a 25% increase in hospital discharges and the severe financial constraints experienced during this implementation period, the NAMP achieved significant efficiency gains through process improvements, while ensuring patient safety and likely improving the quality of care delivered to patients in Ireland.
Health Service Executive-South East, Department of Public Health, Lacken, Kilkenny, County Kilkenny, Ireland.
Orlaith
O
O'Reilly
Health Service Executive-South East, Department of Public Health, Kilkenny, County Kilkenny, Ireland.
Fiona
F
Cianci
Health Service Executive, Quality Improvement Division, Dublin, Ireland.
Avelene
A
Casey
Health Service Executive, National Acute Medicine Programme, Portlaoise, County Laois, Ireland.
Eilish
E
Croke
Health Service Executive, National Acute Medicine Programme, Tullamore, County Offaly, Ireland.
Celine
C
Conroy
Health Service Executive, Special Delivery Unit, Dublin, Ireland.
Anne-Marie
AM
Keown
Health Service Executive-South East, Department of Public Health, Kilkenny, County Kilkenny, Ireland.
Gemma
G
Leane
Blackrock Medical Clinic, Dublin, Ireland.
Barbara
B
Kearns
Beaumont Hospital, Dublin, Ireland.
Shane
S
O'Neill
St. Luke Hospital, Kilkenny, Ireland.
Garry
G
Courtney
D000208:Acute Disease / Q000628:therapy*; D000553:Ambulatory Care / Q000592:standards / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D009313:National Health Programs / Q000592:standards* / Q000639:trends; D005791:Patient Care / Q000592:standards* / Q000639:trends; D010351:Patient Discharge / Q000592:standards / Q000639:trends; D011787:Quality of Health Care / Q000592:standards* / Q000639:trends