Acute Care Fellow: a brief introduction

2011 ◽  
Vol 10 (4) ◽  
Author(s):  
Mark Temple
Keyword(s):  
Medical Care ◽  
Acute Care ◽  
Royal College ◽  
Quality Care ◽  
Good Practice ◽  
High Quality ◽  
Medical Specialties ◽  
Acute Medicine ◽  
High Quality Care ◽  
Acute Medical Care

Chris Roseveare has kindly invited me to introduce myself through this ‘Guest Editorial’ page of Acute Medicine. I was appointed to the new post of Acute Care Fellow at the Royal College of Physicians of London in July of this year. This is a new post, created by the College in recognition of the immense pressures currently being experienced by acute medical services. The remit includes identifying the difficulties faced by physicians in delivering high quality care and seeking out and sharing examples of good practice. I will chair the new acute medical care committee at the College which will have wide representation from all medical specialties involved in the provision of acute medical care. Acute medical units are the hub of the acute medical take and acute medicine will be well represented on the new committee with SAM consultant, trainee and nursing representatives. One practical work stream that is underway is a series of acute care toolkits commissioned by the College. The first on “Handover” was published in May 2011. The second, “High quality acute care”, has just been launched and is available on the Royal College of Physicians’ website: http://www.rcplondon.ac.uk/press-releases/new-toolkit-support-high-quality-care-acutely-ill-patients The toolkits focus on problem areas in acute care and provide practical advice, examples of best practice and recommendations. “High quality acute care” lists 14 key principles of acute care, drafted in close consultation with SAM. One particular concern is the evidence that the outcomes for patients admitted as medical emergencies at week-ends are inferior to those admitted on weekdays. In November 2010 the RCP issued a statement that “Hospitals undertaking admission of acutely ill medical patients should have a consultant physician on site for at least 12 hours per day, seven days per week”. Most acute hospitals are well on the way to providing this level of cover on weekdays – but weekends and bank holidays continue to present a major challenge. The RCP will be working closely with SAM to look at ways in which changes to staffing patterns at weekends can be realised, including reorganisation of rota patterns. Recommendations will be incorporated into a later toolkit.

EDITORIAL VOLUME 19 ISSUE 4: COVID-19: Exemplifying the importance and challenges of Acute Medicine

2020 ◽  
Vol 19 (4) ◽  
pp. 174-175
Author(s):  
Timothy Cooksley ◽  
Keyword(s):  
Medical Care ◽  
Acute Care ◽  
Quality Indicators ◽  
Acute Medicine ◽  
Care Services ◽  
Senior Clinician ◽  
Acute Care Services ◽  
The Impact ◽  
Second Wave ◽  
Acute Medical Care

COVID-19 has challenged healthcare providers and systems. It has dominated the international news agenda for the majority of 2020; arguably opinion becoming more fractured and disparate as the pandemic has evolved. The changing tone of discourse is concerning, although perhaps not surprising. As the majority of the population become increasingly baffled, bored and betrayed desperate for their lives return to “normal”, progressively binary, toxically expressed and opposing scientific views as to how to manage the “second wave” of the pandemic permeate. The initial failings of personal protective equipment (PPE) and a lack of preparedness to face a viral pandemic against the background of a strained acute care sector must not be forgotten and lessons learned. In the UK, COVID-19 has highlighted both the challenges and importance of Acute Medicine. Acute Medicine teams have provided innovative and rapidly adaptive models of care in response to the pandemic. The fundamental tenets of Acute Medicine – MDT working, rapid initiation of treatment, sound use of diagnostics, early senior clinician input and recognition of those in whom ambulatory care is appropriate – are essential components in the management of all acute medical care and demonstrably equally apply to COVID-19. Our increasing global community of Acute Physicians and Acute Medicine teams have once again demonstrated the importance of our specialty. The innovative practice of Acute Medicine teams and the impact of COVID-19 features prominently in this issue of Acute Medicine. There has been wide commentary regarding the impact of COVID-19 on both mental health issues and non-COVID-19 presentations. Riley et al. report an important analysis of presentations to AMU during the first wave of COVID-19 demonstrating a significant change in patient case mix.1 There were increased numbers of presentations potentially associated with social isolation such as falls, alcohol-related pathologies and overdoses alongside smaller numbers of traditionally lower risk presentations, such as non-cardiac chest pain. Ambulatory management of low risk patients with suspected COVID-19 is fundamental to the safety and sustainability of acute care services during the “second wave” and moving forward. Nunan et al. report the experience of the TICC-19 – a virtual ward monitoring oxygen saturations for COVID-19 triaged using a 30 metre rapid walk test.2 This strategy appears safe and feasible with high levels of patient satisfaction and similar models are being utilised across many organisations. The role of POCUS in the diagnosis and management of COVID-19 is increasingly recognised.4 Knight et al. describe a simple aggregated score formed by summating the degree of pleural and interstitial change within six anatomical lung zones showing good discriminatory performance in predicting a range of adverse outcomes in patients with suspected COVID-19.4 This may form an important addition to COVID-19 ambulatory pathways. SAMBA, the Society for Acute Medicine’s Benchmarking Audit, initially focused on the Society’s key quality indicators, continues to flourish and grow. It now not only benchmarks performance but is being used to guide the development of UK clinical quality measures. Colleagues in the Netherlands are commencing similar work and describing international standards of acute medical care, an iterative process, is one of the ultimate goals of this work. SAMBA 19 continues to demonstrate the evolving complexity of acute medical pathways and highlights the need to define optimal quality indicators for acute medical care.5 The inaugural winter SAMBA adds further evidence to the concerns that during this period there is an unfortunate cocktail of both sicker patients and poorer performance.6 Adapting acute medical services to meet this challenge requires innovation and investment. Those working in Acute Medicine should feel proud of their continued contribution to managing the acutely unwell patient and their impact on the sustainability of acute care services, particularly during this most challenging of years. The Society for Acute Medicine has tremendous pride in representing this brilliant workforce. Alongside, the fantastic work of teams this year, there have been multiple emotional and physical stressors. Many AMUs have experienced large numbers of patient deaths, often having to support their loved ones by telephone. The seroprevalence of SARS-CoV-2 was greatest among colleagues working in Acute Medicine.7 Tragically, some AMUs have lost valued colleagues from COVID-19. We remember these friends for their fantastic work they have done, thank them for their contributions to Acute Medicine and on behalf of all the patients they served, we express thanks; their dedication resulted in the ultimate personal sacrifice. They will never be forgotten.

scholarly journals Characteristics of Future Models of Integrated Outpatient Care

Healthcare ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 65
Author(s):  
Alan Leviton ◽  
Julia Oppenheimer ◽  
Madeline Chiujdea ◽  
Annalee Antonetty ◽  
Oluwafemi William Ojo ◽  
...  
Keyword(s):  
Medical Care ◽  
Quality Care ◽  
Care Team ◽  
Fee For Service ◽  
Care Providers ◽  
High Quality ◽  
High Quality Care ◽  
Patient Reported ◽  
Medical Care Team ◽  
Care Costs

Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we described how patients and their families (or caregivers) can work with members of the medical care team to achieve these twin goals of maintaining—and perhaps improving—high-quality care and minimizing costs. We described how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.e., symptoms, events) (ePROs), as frequently as the patient or the medical care team consider appropriate. These capabilities also allow ongoing assessments of physiological measurements/phenomena (mHealth). Remote surveillance of these communications allows longer intervals between (fewer) patient visits to the medical-care team, when this is appropriate, or earlier interventions, when it is appropriate. Systems are now available that alert medical care providers to situations when interventions might be needed.

scholarly journals High Quality Acute Care for the Severely Injured is not Consistently Available in England, Wales and Northern Ireland: Report of a Survey by the Trauma Committee, The Royal College of Surgeons of England

2006 ◽  
Vol 88 (2) ◽  
pp. 103-107 ◽  
Author(s):  
J Browne ◽  
TJ Coats ◽  
DA Lloyd ◽  
PA Oakley ◽  
T Pigott ◽  
...  
Keyword(s):  
Northern Ireland ◽  
Acute Care ◽  
Royal College ◽  
Quality Care ◽  
Major Incident ◽  
Severely Injured ◽  
High Quality ◽  
Airway Control ◽  
Emergency Airway ◽  
British Orthopaedic Association

INTRODUCTION A survey was undertaken to determine the extent to which acute hospitals in England, Wales and Northern Ireland were meeting the acute trauma management standards published in 2000 by The Royal College of Surgeons of England and the British Orthopaedic Association. METHODS A questionnaire comprising 72 questions in 16 categories of management was distributed in July 2003 to all eligible hospitals via the link network of the British Orthopaedic Association. Data were collected over a 3-month period. RESULTS Of 213 eligible hospitals, 161 (76%) responded. In every category of acute care, failure to meet the standards was reported. Only 34 (21%) hospitals met all the 13 indicative standards that were considered pivotal to good trauma care, but all hospitals met at least 7 of these standards. Failures were usually in the organisation of services rather than a lack of resources, with the exception of the inadequate capacity for admission to specialist neurosurgery units. A minority of hospitals reported an inability to provide emergency airway control or insertion of chest tube. The data have not been verified and deficiencies in reporting cannot be excluded. CONCLUSIONS The findings of this survey suggest that high quality care for the severely injured is not available consistently across England, Wales and Northern Ireland, and appear to justify concerns about the ability of the NHS to deal effectively with the current trauma workload and the consequences of a major incident.

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.

Process and outcomes in general practice consultations: Problems in defining high quality care

1995 ◽  
Vol 41 (7) ◽  
pp. 969-975 ◽  
Author(s):  
Helen R. Winefield ◽  
Timothy G. Murrell ◽  
Julie Clifford
Keyword(s):  
General Practice ◽  
Quality Care ◽  
High Quality ◽  
High Quality Care

scholarly journals Influencing factors for high quality care on postpartum haemorrhage in the Netherlands: patient and professional perspectives

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Mallory D. Woiski ◽  
Evelien Belfroid ◽  
Janine Liefers ◽  
Richard P. Grol ◽  
Hubertina C. Scheepers ◽  
...  
Keyword(s):  
The Netherlands ◽  
Influencing Factors ◽  
Postpartum Haemorrhage ◽  
Quality Care ◽  
High Quality ◽  
High Quality Care ◽  
Professional Perspectives

Teledermatology Can Produce High-Quality Care at Low Cost

2003 ◽  
Vol 11 (4) ◽  
pp. 209-215 ◽  
Author(s):  
Keng Chen ◽  
Stephen Shumack ◽  
Richard Wootton
Keyword(s):  
Low Cost ◽  
Quality Care ◽  
High Quality ◽  
High Quality Care

Further steps to define and deliver high quality care for care clusters: the mental health care clusters and pathways website

2013 ◽  
Vol 18 (1) ◽  
pp. 4-13
Author(s):  
Michael Clark ◽  
Clare Hilton ◽  
Wendy Shiels ◽  
Carole Green ◽  
Christina Walters ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Quality Care ◽  
High Quality ◽  
High Quality Care
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