HN Summary
• Hamilton Health Sciences’ Urgent Medicine Day Unit (UMED) is a first-of-its-kind pilot providing rapid, hospital-level outpatient care to patients with complex conditions, helping them avoid emergency department visits and hospital admissions.
• The program offers same-day diagnostics, treatment, and specialist consultations with inpatient-level priority, improving patient flow while preserving hospital capacity.
• Early results show UMED is enhancing patient experience and outcomes by delivering faster, coordinated care that allows patients to recover safely at home.
Innovative pilot program reduces ED visits and overnight stays.
aneck Mistry has been rushed to the emergency department (ED) at Hamilton Health Sciences’ Hamilton General Hospital (HGH) more times than he can count, frequently being admitted for help getting his health issues under control.
Debilitating complications from weight-loss surgeries, including dangerous dehydration, have plagued Mistry for over a decade. These bouts of dehydration were so severe, Mistry would lose balance or even consciousness and fall, triggering an ED trip.
“Most of the time I would be admitted to hospital,” says Mistry, whose long-term health complications also include being prone to infections. His hospital stays lasted days or even weeks depending on the issue.
Lately though, Mistry and the HGH ED team haven’t been crossing paths. That’s because instead of living crisis-to-crisis, Mistry was referred to the hospital’s new Urgent Medicine Day Unit (UMED) pilot program for care and monitoring.
Launched last fall at HGH, the UMED program is the only one of its kind in Ontario, and possibly in Canada. Its goal is simple: get patients the care they need quickly so they can stay well and avoid being admitted to hospital.
Open weekdays, UMED is staffed by doctors and nurses who provide rapid follow-up care for people living with serious, long-term health conditions that can worsen quickly. Patients are referred by the hospital’s ED and internal medicine team. So far, the UMED has seen more than 500 patients across about 800 visits. UMED patients are given the same high priority as hospitalized patients.
Proactive care
Early intervention by the UMED helps prevent multiple trips to the ED and also frees up hospital beds by safely providing hospital-level care in an outpatient setting.
The UMED also treats people who arrive at the ED with a sudden, potentially serious issue like chest pain. If their ED doctor feels, based on an examination and testing, that they can safely return home, they’re booked into the UMED the next day for follow-up care including additional testing.
UMED’s care includes blood work; X-rays, CT scans and MRIs; IV infusions; and consultations with specialists. It all happens on the same day, and it’s also common for patients to receive test results and a diagnosis the same day.
“It’s an easy in-and-out for patients, and the doctors and nurses do a great job,” says Mistry. “The best thing they did for Hamilton General Hospital, and for its emergency department, was to establish the UMED.”
Solving complicated problems fast
UMED is one of several initiatives underway at HHS to improve patient flow and safeguard hospital capacity amid growing demand. As a regional centre for specialized care, HHS serves patients from well beyond Hamilton — making it critical to preserve access to beds for those requiring complex treatment.
“Given the choice, most people would rather be at home than in a hospital bed or crowded ED waiting for a bed,” says Dr. Samir Raza, deputy chief of medicine at HHS and UMED physician lead. “With the UMED, we’re delivering hospital-level care on an outpatient basis. Patients get the urgent, comprehensive treatment they need while resting and recovering at home.”
The UMED team was able to give Mistry the hydration he needed without using an IV, PICC or Hickman line – methods that left him vulnerable to infections. An IV line is a small tube placed in a vein to give fluids or medication, while PICC and Hickman lines are longer-term tubes placed in larger veins when someone needs ongoing treatment over weeks or months.
Instead, the team used a different kind of small needle that goes into the skin, with a much lower chance of infection.
Mistry’s started at the UMED with once-a-week visits that tapered down. Now, he visits on an as-needed basis. “If I have an issue I call the UMED and they book me in immediately,” he says.
Equal urgency for UMED and hospitalized patients
It is standard practice in hospitals for inpatients (hospitalized patients) to get priority over outpatients (who visit from home for care) when it comes to urgent follow-up care, like scans and appointments with specialists.
“Tests for outpatients aren’t given the same priority as inpatients, so booking appointments and getting results can take much longer,” says Raza. That’s why, prior to UMED, it was common practice for HGH’s physicians to admit patients to hospital, even when it was safe to send them home, so they could get fast follow-up tests. But this also meant that medically stable patients were occupying hospital beds.
UMED’s patients have the same high priority as hospitalized patients. “They move to the front of the line for urgent follow-up care, so they don’t have to spend weeks or even months going for tests and appointments,” says Raza, adding, “They aren’t bounced around. They visit our UMED and get everything they need in one place, very quickly.”
Next Steps
There has been a lot of interest in UMED since it launched last fall, says Raza, adding that the team has received funding to incorporate virtual care and enhanced at home monitoring of patients.
“UMED’s goal is to always consider ways to provide faster, coordinated and comprehensive care to those whose health is rapidly deteriorating, as outpatients, so they can safely stay in their homes.”