Abstract
The Local Health Unit of Alentejo Litoral (ULSLA), is a healthcare network, from Portuguese National Healthcare System, covers a 5310km2.and comprises one hospital and five primary care health units, serving a population of 105 000 patients- 26.4% aged over 65, 12% migrants, and 28.6% with very low literacy.
The Ambulatory Care Medical Unit (UMA) is a strategic alternative for the reorganization of care for acute or chronic diseases, prioritizing ambulatory, and easy access to care. UMA includes a non-oncologic multipurpose Day Hospital; two specific consultations - Post Discharge Reassessment Appointment (PDRA) and Rapid Diagnosis Appointment (RDA); the liaison team for heart failure and multimorbidity care pathways.
The UMA main´s objectives include a proactive, and timely response to people with clinical situations that not being critical, or requiring hospitalization, need a quick response, such us non-emergent acute illness or exacerbations of chronic diseases.
UMA pretend to be an alternative response to the Emergency Department (ED) and avoidable admissions. Also intends to contribute to reduce care fragmentation, being a bridge between hospital, primary, nursing homes and home care, with consultancy and easy access.
UMA has a resident multidisciplinary team: internal medicine consultants (2), nurses (4) care assistants (2) and secretariat (1). Psychologist, social worker, or nutritionist are shared with other departments. Staff of other services can use the facilities. It´s open from Monday to Friday between 9:00am-17:00pm. There are a dedicated cellphone and email for easy communication.
Referrals can be made by hospital, primary care, long term care doctors. Patients and caregivers can also directly contact the staff.
The medical team is responsible for triage, observation, treatment, and guidance of the patients. The nurse staff collect blood samples or others, manages the therapies, help with procedures, and empower patients and careers. Continuity of care is guaranteed to all patients.
To achieve the goals, care and communication channels were reorganized and established protocols with external and inner services (Imaging, Laboratory, Gastroenterology and Pneumology etc).
From July 2022 to 15st November 2023, the main results are:
Day Hospital - 1177 patients; median age of 76, with 2643 treatment sessions, average 2,16 session/patient. Main referrals origin: Outpatient Clinic (OPC) -55,7%; ED -18%; Primary Care (PC) – 11%; unscheduled sessions – 5%.
3,7% patients, needs directly ward admission, but had a 64.7% reduction in ED visits.
RDA – Were carried out 222 appointments with a ratio 1.24 appointments/ patient; Median age 68y. Referrals sources: ED (57%), OPC (30%). The main referral cause was suspected neoplastic disease. Average times: referral - first appointment 9 days; diagnostic hypothese-21 days. 12% of patients needed ward admission for diagnostic procedures.
PDRA - Were carried out 403 appointments with a ratio 1.03 appointments/patient. Most referrals come from ED (63%). All patients were forwarded to Internal Medicine consultation or GP.
UMA provides proactive and flexible ambulatory responses. Prioritizing patient and provider’s needs, we aim to continue improving coordination and continuity of care, while tracking the impact on outcomes, experiences, and system efficiency.