scholarly journals Delirium risk stratification in consecutive unselected admissions to acute medicine: validation of a susceptibility score based on factors identified externally in pooled data for use at entry to the acute care pathway

2016 ◽  
Author(s):  
Sarah T. Pendlebury ◽  
Nicola G. Lovett ◽  
Sarah C. Smith ◽  
Rose Wharton ◽  
Peter M. Rothwell
Keyword(s):  
Risk Stratification ◽  
Acute Care ◽  
Care Pathway ◽  
Acute Medicine ◽  
Pooled Data ◽  
Susceptibility Score

scholarly journals Getting information across the acute medicine and primary care interface – steps in the right direction

2018 ◽  
Vol 17 (2) ◽  
pp. 60-60
Author(s):  
Daniel Lasserson ◽  
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Acute Care ◽  
Information Needs ◽  
Care Pathway ◽  
Acute Medicine ◽  
Nice Guidance ◽  
Reduce Risk ◽  
The Right ◽  
Acute Medical Care

In the acute care pathway, patients often need to move from home to hospital and for the majority, back again. This movement across care interfaces ensures that assessments and interventions are delivered to reduce risk of harm and enhance recovery. However, information needs to move across interfaces too, which enables the clinician taking over care to understand the problem, what has been done and what remains to be done. This is as important for the journey into hospital as it is for the journey home again and is highlighted in the forthcoming NICE guidance on Emergency and Acute Medical Care.

Predictive Modeling for Adverse Events and Risk Stratification Programs for People Receiving Cancer Treatment

2021 ◽  
pp. OP.21.00198
Author(s):  
Chelsea K. Osterman ◽  
Hanna K. Sanoff ◽  
William A. Wood ◽  
Megan Fasold ◽  
Jennifer Elston Lafata
Keyword(s):  
Clinical Practice ◽  
Risk Stratification ◽  
Cancer Treatment ◽  
Acute Care ◽  
Predictive Modeling ◽  
Predictive Models ◽  
Emergency Department Visits ◽  
Targeted Interventions ◽  
Risk Algorithm ◽  
Oncology Care

Emergency department visits and hospitalizations are common among people receiving cancer treatment, accounting for a large proportion of spending in oncology care and negatively affecting quality of life. As oncology care shifts toward value- and quality-based payment models, there is a need to develop interventions that can prevent these costly and low-value events among people receiving cancer treatment. Risk stratification programs have the potential to address this need and optimally would consist of three components: (1) a risk stratification algorithm that accurately identifies patients with modifiable risk(s), (2) intervention(s) that successfully reduce this risk, and (3) the ability to implement the risk algorithm and intervention(s) in an adaptable and sustainable way. Predictive modeling is a common method of risk stratification, and although a number of predictive models have been developed for use in oncology care, they have rarely been tested alongside corresponding interventions or developed with implementation in clinical practice as an explicit consideration. In this article, we review the available published predictive models for treatment-related toxicity or acute care events among people receiving cancer treatment and highlight challenges faced when attempting to use these models in practice. To move the field of risk-stratified oncology care forward, we argue that it is critical to evaluate predictive models alongside targeted interventions that address modifiable risks and to demonstrate that these two key components can be implemented within clinical practice to avoid unplanned acute care events among people receiving cancer treatment.

The management of acute shortness of breath in young adults

2013 ◽  
Vol 99 (3) ◽  
pp. 92-96
Author(s):  
V Y Ahuja ◽  
D Freshwater
Keyword(s):  
Young Adults ◽  
Differential Diagnosis ◽  
Risk Stratification ◽  
Acute Care ◽  
Common Type ◽  
Shortness Of Breath ◽  
The Third ◽  
Significant Pathology ◽  
Key Features ◽  
Simultaneous Assessment

AbstractShortness of breath (SOB), or dyspnoea, is a common presenting symptom in acute care, responsible for 8% of all 999 calls to the ambulance service and ranking as the third most common type of emergency call (1). It may be associated with significant pathology, so prompt identification and appropriate management are therefore imperative. Although a formal diagnosis guides risk stratification, prognostication and treatment, it must not delay resuscitation. Rather, the management of an acutely short of breath (ASOB) patient must follow an algorithm incorporating simultaneous assessment and resuscitation. This article discusses both of these aspects in some detail, as well as key features in the history and the differential diagnosis, before concluding with some consideration of how the different operational environments in which such patients can present may affect their management.

Response to Letter to the editor: Acute Medicine Journal

2020 ◽  
Vol 19 (1) ◽  
pp. 57-57
Author(s):  
Ben Chadwick ◽  
◽  
Nick Murch ◽  
Anika Wijewardane ◽  
◽  
...  
Keyword(s):  
Internal Medicine ◽  
Acute Care ◽  
Working Group ◽  
Point Of Care ◽  
Early Years ◽  
Point Of Care Ultrasound ◽  
Acute Medicine ◽  
Front Door ◽  
Medicine Journal ◽  
Wide Range

Editor- Thank you for giving us the opportunity to respond to the letter received regarding the Joint Royal College of Physicians Training Board (JRCPTB) curriculum for Acute Internal Medicine (AIM) that has previously been circulated for comment and consideration of implementation in August 2022. Dr Williamson is correct in asserting that the proposed curriculum hopes to produce doctors with generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of medical symptoms and conditions. It does aim to produce a workforce that reflects the current trends of increasing patient attendances to both primary care and emergency departments- one that has a high level of diagnostic reasoning, the ability to manage uncertainty, deal with co-morbidities and recognise when specialty input is required in a variety of settings, including ambulatory and critical care. Contrary to the situation described in the correspondence, the new curriculum does not move away from each trainee being required to develop a specialist skill, such as medical education, management, stroke medicine or focused echocardiography. Trainees will still need to acquire competency in a specialist skill for their final 36 months of their training programme, usually after they have completed their Point of Care Ultrasound (POCUS) certification. The thinking behind introducing mandatory POCUS in the curriculum is that: POCUS is in the proposed curricula for intensive care medicine, respiratory medicine and emergency medicine, therefore we feel that in order to recruit the best trainees it is imperative POCUS training is offered as standard As evidenced by the trainee surveys, they often do not get allocated time to develop their specialist skill, especially in the early years of Higher Specialty Training before they often have decided on a particular skill. The introduction of mandatory POCUS training should legtimise time off the ward to obtain this skill early in training. POCUS is becoming more and more standardised in 21st Century acute care alongside the reducing costs of Ultrasound probe e.g. Philips Lumify and Butterfly iQ which are compatible with smart phones POCUS has been heralded as the fifth pillar of examination (observation, palpation, percussion, auscultation, insonation)1 The proposed curriculum therefore facilitates trainees to have regular dedicated time to develop interests inside or outside acute medicine to supplement their professional experience and training. This will also enable trainees to have time away from the ‘front door’ high intensity acute care. Mandatory POCUS will continue to set AIM training apart from other physician training programmes and continue to attract high quality trainees to apply to the specialty. Formal feedback seen at the SAC meeting in October 2019 to the draft curriculum (personal correspondence from JRCPTB) showed a positive response from nine individuals, an ambivalent one from two people, and only two against the introduction of formal POCUS training in the curriculum. Point of Care Ultrasound will likely be a welcome addition to the curriculum and will benefit patients, trainees and front door services up and down the country. Concerns regarding supervision are being addressed by the POCUS working group, in anticipation of the lead in period of well over two years. It is anticipated that most trainees can achieve POCUS sign off (e.g. Focused Acute Medical Ultrasound) in 6 to 12 months (personal correspondence Nick Smallwood from POCUS working group). With ongoing concerns regarding recruitment and retention in Acute Internal Medicine we agree strongly that with POCUS inclusion, we have a further selling point for AIM training.

P2-390: Developing a Dementia Care Pathway in Acute Care Hospitals: A Review of the Literature

2016 ◽  
Vol 12 ◽  
pp. P794-P795
Author(s):  
Sara Berman Mitchell ◽  
Edward Etchells ◽  
Sandra E. Black ◽  
Mario Masellis
Keyword(s):  
Acute Care ◽  
Care Pathway ◽  
Acute Care Hospitals ◽  
Dementia Care ◽  
Review Of The Literature

scholarly journals Editorial Volume 19 Issue 1 – “Eternal Winter”: Acute Medicine the key to providing longer periods of summer

2020 ◽  
Vol 19 (1) ◽  
pp. 2-3
Author(s):  
Tim Cooksley ◽  
Keyword(s):  
Respiratory Rate ◽  
Ambulatory Care ◽  
Acute Care ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Point Of Care Testing ◽  
Acute Medicine ◽  
Care Services ◽  
Acute Care Services ◽  
The Impact

As another winter season passes, many colleagues will continue to be working under immense pressures striving to provide high quality care for increasingly larger numbers of patients. The work of Acute Medicine teams to keep the “front door” safe are fundamental to the delivery and sustainability of acute care services. The challenges of innovating and enacting positive changes at times of such high service demand are not insignificant; but the specialty is blessed with rapidly expanding driven and dedicated international, national and local leaders. The first winter SAMBA has recently been performed. SAMBA is an increasingly rich data source that will serve both nationally and locally to help improve performance and ultimately patient outcomes.1 Higher quality Acute Medicine is being produced. Acute Physicians are leading in many acute sub-specialties. Pleasingly, there has a been a significant rise in the number of trainees applying to train in Acute Medicine in the UK reflecting the traction the specialty is achieving. Ambulatory care remains a fundamental tenet to the sustainability of acute care services. Point of care testing is a key element in driving efficient performance in this setting and in this issue Verbakel et al. perform an important analysis on the reliability of point of care testing to support community based ambulatory care.2 This work should field the way for further research defining the impact of point of care testing and how it should be implemented in ambulatory clinical practice. The performance of respiratory rate observation remains poorly performed in acute care settings despite its well validated predictive value. Nakitende et al. describe an app that allows respiratory rate to calculated more quickly and accurately by using a touch screen method.3 Technological innovations to improve the recording and accuracy of physiological parameters in acute care, which can also be used in resource poor settings, will be a focus of large quantities of research in the upcoming years. Blessing et al. describe an important modelling study on the impact of integrated radiology units.4 Co-ordination between Acute Medicine and Radiology departments is essential in a high functioning AMU, especially as increasingly Acute Physicians are trained in point of care ultrasound. Lees-Deutsch et al. provide a fascinating insight into the patient’s perspective of discharge lounges.5 Often used to help maintain flow through the hospital, they elucidate that patients and caregivers transferred from AMU do not find this aspect of their journey a positive one. In times of significant organisational pressures, it is important that clinicians continue to examine the impact of flow measures on the quality of patient care and experience.

scholarly journals Trainees Update

2007 ◽  
Vol 6 (2) ◽  
pp. 89-89
Author(s):  
Hannah Skene ◽  
Keyword(s):  
Acute Care ◽  
Medical Training ◽  
Acute Medicine ◽  
Strong Position ◽  
The Uk

It has certainly been a huge year of change for all of us in training posts, and in acute medicine particularly. There are now trainees in Acute Care Common Stem (ACCS) and Core Medical Training (CMT) programmes as well as new posts at ST3 level and above. Across the UK we have doubled the number of specialty trainees in Acute Medicine, and the specialty is in a very strong position.

scholarly journals Frailty assessment and acute frailty service provision in the UK: results of a national ‘day of care’ survey

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Thomas Knight ◽  
Catherine Atkin ◽  
Finbarr C Martin ◽  
Chris Subbe ◽  
Mark Holland ◽  
...  
Keyword(s):  
Acute Care ◽  
Assessment Tool ◽  
Care Delivery ◽  
Care Pathway ◽  
National Policy ◽  
Assessment Tools ◽  
Screening Policy ◽  
Frailty Assessment ◽  
Care Survey ◽  
The Uk

Abstract Background The incorporation of acute frailty services into the acute care pathway is increasingly common. The prevalence and impact of acute frailty services in the UK are currently unclear. Methods The Society for Acute Medicine Benchmarking Audit (SAMBA) is a day of care survey undertaken annually within the UK. SAMBA 2019 (SAMBA19) took place on Thursday 27th June 2019. A questionnaire was used to collect hospital and patient-level data on the structure and organisation of acute care delivery. SAMBA19 sought to establish the frequency of frailty assessment tool use and describe acute frailty services nationally. Hospitals were classified based on the presence of acute frailty services and metrics of performance compared. Results A total of 3218 patients aged ≥70 admitted to 129 hospitals were recorded in SAMBA19. The use of frailty assessment tools was reported in 80 (62.0%) hospitals. The proportion of patients assessed for the presence of frailty in individual hospitals ranged from 2.2 to 100%. Bedded Acute Frailty Units were reported in 65 (50.3%) hospitals. There was significant variation in admission rates between hospitals. This was not explained by the presence of a frailty screening policy or presence of a dedicated frailty unit. Conclusion Two fifths of participating UK hospitals did not have a routine frailty screening policy: where this existed, rates of assessment for frailty were variable and most at-risk patients were not assessed. Responses to positive results were poorly defined. The provision of acute frailty services is variable throughout the UK. Improvement is needed for the aspirations of national policy to be fully realised.

scholarly journals Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary research

2014 ◽  
Vol 2 (5) ◽  
pp. 1-144 ◽  
Author(s):  
Mark Sujan ◽  
Peter Spurgeon ◽  
Matthew Inada-Kim ◽  
Michelle Rudd ◽  
Larry Fitton ◽  
...  
Keyword(s):  
Emergency Care ◽  
Social Issues ◽  
Care Pathway ◽  
Patient Flow ◽  
Convenience Sample ◽  
Acute Medicine ◽  
Clinical Handover ◽  
Trade Offs ◽  
Organisational Factors

Background and objectivesHandover and communication failures are a recognised threat to patient safety. Handover in emergency care is a particularly vulnerable activity owing to the high-risk context and overcrowded conditions. In addition, handover frequently takes place across the boundaries of organisations that have different goals and motivations, and that exhibit different local cultures and behaviours. This study aimed to explore the risks associated with handover failure in the emergency care pathway, and to identify organisational factors that impact on the quality of handover.MethodsThree NHS emergency care pathways were studied. The study used a qualitative design. Risks were explored in nine focus group-based risk analysis sessions using failure mode and effects analysis (FMEA). A total of 270 handovers between ambulance and the emergency department (ED), and the ED and acute medicine were audio-recorded, transcribed and analysed using conversation analysis. Organisational factors were explored through thematic analysis of semistructured interviews with a purposive convenience sample of 39 staff across the three pathways.ResultsHandover can serve different functions, such as management of capacity and demand, transfer of responsibility and delegation of aspects of care, communication of different types of information, and the prioritisation of patients or highlighting of specific aspects of their care. Many of the identified handover failure modes are linked causally to capacity and patient flow issues. Across the sites, resuscitation handovers lasted between 38 seconds and 4 minutes, handovers for patients with major injuries lasted between 30 seconds and 6 minutes, and referrals to acute medicine lasted between 1 minute and approximately 7 minutes. Only between 1.5% and 5% of handover communication content related to the communication of social issues. Interview participants described a range of tensions inherent in handover that require dynamic trade-offs. These are related to documentation, the verbal communication, the transfer of responsibility and the different goals and motivations that a handover may serve. Participants also described the management of flow of patients and of information across organisational boundaries as one of the most important factors influencing the quality of handover. This includes management of patient flows in and out of departments, the influence of time-related performance targets, and the collaboration between organisations and departments. The two themes are related. The management of patient flow influences the way trade-offs around inner tensions are made, and, on the other hand, one of the goals of handover is ensuring adequate management of patient flows.ConclusionsThe research findings suggest that handover should be understood as a sociotechnical activity embedded in clinical and organisational practice. Capacity, patient flow and national targets, and the quality of handover are intricately related, and should be addressed together. Improvement efforts should focus on providing practitioners with flexibility to make trade-offs in order to resolve tensions inherent in handover. Collaborative holistic system analysis and greater cultural awareness and collaboration across organisations should be pursued.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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