The Assessment Process Explained

Patients are usually referred to the Acute Medical Unit (AMU) by their GP but 30% of our patients come via the Emergency Department and sometimes patients are referred to us from out-patient clinics, from specialist nursing staff in the community or directly from Paramedics working for the Scottish Ambulance Service.

The person referring you to our team will have some idea of what they think may be the problem and following discussion with one of our AMU Consultants we will chose the best place in the unit to fit your needs so that we can get the bottom of the matter as quickly as possible.

  • Bedded Assessment Area is for patients who are more unwell, likely need to be admitted to hospital for more than 12 hours or who are too physically frail to be managed in the Ambulatory Assessment Area
  • Ambulatory Assessment Area is for patients who are very stable with their illness or those unlikely to need admission into hospital

Bedded Assessment Area

We have a 31 bedded Acute Medical Unit and this is the area where patients who require admission to hospital will be seen or those who are too unwell or frail to be assessed in the Ambulatory Assessment Area.

Patients will be seen initially by one of our skilled nursing team, who will carry out a set of observations (blood pressure, pulse, oxygen levels, temperature) and will ask some basic questions including essential information about who to contact while you are in hospital. They will then let the medical team know that you are ready to be assessed.

You will then have a comprehensive assessment by one of our trainee doctors and have your investigations, such as bloods and x-rays, ordered and often treatment such as fluids, pain killers and/or antibiotics initiated.

You will then be reviewed by a Medical Consultant, often once your investigation results are back. This may be a Consultant from the Acute Medical Team or it may be a Specialist Team Consultant such as a Respiratory Physician, Gastroenterologist, Cardiologist or Medicine for the Elderly Physician. This is often determined following your initial assessment by junior doctor.

Some patients who are assessed in the bedded area will be admitted to a medical ward, while others will not require admission and once your test results become available you can be discharged directly home.

Ambulatory Assessment Area

Our Ambulatory Assessment Area (AAA) is an area of AMU where our skilled doctors and nurses can assess patients and order investigations to help expedite diagnoses and treatments of urgent conditions. These conditions are often too serious to await review in an out-patient clinic but the patient is stable enough to be assessed in the AAA and are often managed on an out-patient basis.

Common conditions managed in the AAA are:
  • DVT assessment & treatment
  • Headache assessment & treatment
  • Some forms of chest pain & breathlessness
  • Cellulitis
  • Follow up scans
  • Follow up review by one of the AMU Team

However, some patients who attend AAA may require to be admitted to AMU following assessment by the team. In this case, a bed will be arranged either in AMU or directly on one of the specialist medical wards.
Investigation, observation and treatment diagram
No matter which part of the unit your care takes place in, it all happens in roughly the same way. All patients will have a comprehensive review appropriate to their particular health needs and the team will then order the best investigations to make a diagnosis and plan treatment; in some cases they will start treatment straight away whilst awaiting the test results. Observation of your condition is also a vital part of the dynamic process of assessment and helps to inform us not only of what could be wrong but also how you are responding to any treatment given.

Once we have the initial results and observation data a further review and discussion between your nursing staff, junior doctors, senior doctors and you will decide what the next steps are. This could be more tests and observation under our care, a transfer to continue your treatment under another team in the hospital or home with further out patient tests or GP care.

Unfortunately, the time taken to do this differs greatly for each person and each medical condition - some patients only need a couple of blood tests before they are safe for home and some patients require prolonged observation and complicated investigations which take longer to arrange and deliver. We do this as efficiently and safely as we possibly can, but as we work with many different departments in the hospital who are in turn dealing with many other patients we cannot always predict how long this will take. A day on the unit with us can be long and can sometimes be frustrating while you are waiting to get tests done or waiting for results. There are 2 televisions on the unit and free patient WiFi is available. We also provide a variety of reading material for you and are happy to allow patients to take a walk about the hospital grounds or the Arboretum if it's safe to do so.

Getting home safely

If your care and treatment have been completed on the AMU and you're safe to go home there are some vital steps our team take to make sure this is done as safely as possible:

Mobility and care in the community
As many of our patients are elderly there are sometimes some unknown needs which come to light during a hospital stay. That could be the result of a new illness causing set back or could be support now required at home due to a gradual decline in ability. We strive to provide all patients over the age of 75 years with a 'Functional Assessment' which not only looks at how they are physcially coping in their home environment but also how their memory is and how their carers/support network are doing. If there are concerns raised this is then assessed by the multidisciplinary team and we can look at a supported discharge, a discharge to an intermediate setting to improve function or a longer stay in hospital.

Discharge Medication
Medication wastage is a huge problem in NHS Scotland which we don't want to add to. If you have only been with us for a short period of time then we will make sure that you have a sufficient supply of your medication at home to last until your next prescription rather than automatically issuing you with another few weeks worth of tablets and inhalers. We will always give you an adequate supply of any new medication started in hospital and a full course of antibiotics if needed. If you feel that you do not have sufficient medication to last when you go home you must let your nurse, doctor or one of our pharmacists know in time for us to be able to address that for you.

Follow up of tests and care
Most patients leave our unit without the need to come back for review or come back for more tests. If you do have out patient investigations we will make sure these are organised and we will review the results once they are done. In the majority of cases we will not need to see you again and the medical team will write to you and your GP to let you know the outcome. If we do want to see you back on the unit don't be alarmed! There are some more complex or unusual patients that we need to keep a closer eye on to be sure we have things right. We always write to your GP about your time with us on the unit and endeavour to do this within 14 days of your discharge.

If you feel follow up has been missed or you have not been contacted about coming back for a test that we discussed with you please contact the Acute Medical Unit secretarial team directly on 01382 740580 or via the Ninewells Switchboard (01382 660111).
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1926 - 2022