RESUMEN
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. METHOD: 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. CONCLUSION: 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.
