A Rapid Access Medical Service (RAMS) Model as an Effective Mean of Reducing Emergency Department (ED) Presentation and Hospital Admissions

Dirk Hofmann, Southern Adelaide Local Health Network (SALHN)

Sharyn Onley, Stephen Basso, E. Michael Shanahan
Southern Adelaide Local Health Network (SALHN), Adelaide, Australia, Flinders University

Aims: SALHN has experienced a progressive increase of patient presentations to the ED with a concomitant increase in hospital admissions. . As part of hospital avoidance strategy we developed a physician led ambulatory rapid access service. 

RAMS offers rapid access for patients with semi –urgent medical conditions (judged too sick to wait for months to be seen in a typical outpatient clinic but not obviously requiring emergency hospital admission) referred by their General Practitioners (GP). The referrals were screened by an experienced nurse practitioner. Patients were supposed to be seen within 48 hours by a senior medical specialist and a comprehensive management plan faxed to the referring GP within 24hours. If deemed necessary, the patient received a maximum of 1 review. The specialists recorded probable ED or hospital avoidance. Ten practitioners attended to patients at RAMS. 

In the first year of operation, 434 patients were assessed (327 new, 107 reviews). 95% were seen within 48hours. 83.3% of management plans were faxed to the referring GP within 24hours and 95.9% within 48 hours.
1.4% of the patients required hospital admission. 40.8% were deemed ED presentation prevention, 19.8% deemed hospital admission prevention. The combined cost savings amounted to ~AU$415000.-.

Estimates of patient and GP satisfaction were very high. The average patient satisfaction was 4.7 on a scale of 1 - 5 and 94% of GPs were satisfied or very satisfied with the service. 

A consultant led rapid referral service is cost effective as a hospital avoidance strategy. It is very popular with patients and general practitioners.