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.

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.

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.

Care pathways: challenges and opportunities for restorative dentistry

2013 ◽  
Vol 4 (3) ◽  
pp. 142-144
Author(s):  
Paul Brunton
Keyword(s):  
Primary Care ◽  
National Health Service ◽  
Care Pathway ◽  
Primary Care Trust ◽  
Care Pathways ◽  
Restorative Dentistry ◽  
Treatment Review ◽  
Challenges And Opportunities ◽  
Subsequent Recall ◽  
The Right

In the future, dental care in England, both in the primary and secondary sectors, will be delivered increasingly via care pathways. A care pathway describes in detail a patient’s journey from referral to treatment, review and subsequent recall if required. It provides for the right person treating the right patients at the right time for the right condition in the right situation. It is the intention at a central National Health Service (NHS) level that these pathways will operate in managed clinical networks that will be consultant and/or specialist led. There are already several successful pilots running in England. A good example is the periodontic and endodontic service provided by three enhanced practitioners in the Bradford and Airedale primary care trust (PCT).

scholarly journals Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

2016 ◽  
Vol Volume 12 ◽  
pp. 1-9 ◽  
Author(s):  
Niklas Ekerstad ◽  
Björn Karlson ◽  
Synneve Dahlin Ivanoff ◽  
Sten Landahl ◽  
David Andersson ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Medical Care ◽  
Acute Care ◽  
Geriatric Assessment ◽  
Frail Elderly ◽  
Comprehensive Geriatric Assessment ◽  
Assessment Unit ◽  
Acute Medical Care

Modern Civilistic Instruments of Medical Reform: Issues of Law Implementation and Law Enforcement

2020 ◽  
Vol 27 (3) ◽  
pp. 109-127
Author(s):  
Iryna Senyuta
Keyword(s):  
Primary Care ◽  
Law Enforcement ◽  
Medical Care ◽  
Primary Care Physician ◽  
Legal Regulation ◽  
Care Physician ◽  
Third Parties ◽  
Medical Reform ◽  
Judicial Practice ◽  
The Right

The study of the latest civilistic instruments of medical reform is conditioned by its purpose, which is to clarify the legal nature of the declaration of choice of primary care physician and the contract for medical care under the programme of medical guarantees, highlighting the specific features of the right to choose a doctor, conditioned by the outlined tolls, as well as identifying gaps and controversies in the legislation of Ukraine and judicial practice in law enforcement in this area. The main method of the study was the method of studying judicial practice, which allowed to assess the effectiveness of law enforcement, the level of perception of legislation in this area in practice, as well as to determine the necessity of improving the legal regulation. The study highlights the problematic aspects related to the exercise of the right to free choice of a doctor, in particular due to legislative changes regarding medical reform. The legal essence of the declaration on the choice of a primary care physician has been covered. The study clarifies that it is not a transaction, but a document certifying the exercise of the right to freely choose a primary care physician. The contract on medical care of the population under the programme of medical guarantees is analysed and its civil law matter is established. It is determined that it is a contract for the provision of services under the public procurement, concluded for the benefit of third parties. The reimbursement agreement was also investigated, which is also an agreement in favour of third parties – patients in terms of full or partial payment for their medicines. The judicial practice is analysed, which gives grounds to assert the problems with enforcement and administration of law, and proposals are made to improve the current legislation, including in the aspect of the subject of the contract under the programme of medical guarantees. The "legitimate expectation" that arises in a person in the presence of regulatory guarantees is under conventional protection, as illustrated by the European Court of Human Rights in its decisions, and to change the paradigm of implementation requires a transformation of legislation. The practical significance of this study is to intensify scientific intelligence in this direction, to improve the legal regulation of these innovative legal constructions, to optimise the enforcement and administration of law in the outlined civilistic plane

scholarly journals Acute medical care. The right person, in the right setting – first time: how does practice match the report recommendations?

2009 ◽  
Vol 9 (6) ◽  
pp. 553-556 ◽  
Author(s):  
David Ward ◽  
Jonathan Potter ◽  
Jane Ingham ◽  
Fran Percival ◽  
Derek Bell
Keyword(s):  
Medical Care ◽  
The Right ◽  
First Time ◽  
Acute Medical Care

scholarly journals Evaluation of the clinical and cost-effectiveness of the York Faecal Calprotectin Care Pathway

2018 ◽  
Vol 9 (4) ◽  
pp. 285-294 ◽  
Author(s):  
James Turvill ◽  
Daniel Turnock ◽  
Hayden Holmes ◽  
Alison Jones ◽  
Eleanor Mclaughlan ◽  
...  
Keyword(s):  
Primary Care ◽  
Outcome Measures ◽  
Sensitivity And Specificity ◽  
Care Pathway ◽  
Faecal Calprotectin ◽  
Reactive Protein ◽  
Cost Consequence ◽  
Nice Guidance ◽  
Irritable Bowel ◽  
Primary Care Practices

ObjectiveTo evaluate the sensitivity and specificity of the York Faecal Calprotectin Care Pathway (YFCCP) and undertake a health economics analysis. The YFCCP has been introduced in support of the National Institute for Health and Care Excellence (NICE) guidance DG11. It is designed to improve the sensitivity and specificity of faecal calprotectin (FC) in discriminating the irritable bowel syndrome from inflammatory bowel disease in primary care.DesignTo prospectively evaluate the clinical outcomes at 6 months of the first 1005 patients entering the YFCCP. To develop a cost-consequence model using two comparators: one based on clinical assessment and the C reactive protein/erythrocyte sedimentation rate without using FC, and the second using single testing of the standard FC cut-off.SettingNorth Yorkshire primary care practices.PatientsPrimary care patients fulfilling NICE DG11.InterventionsThe YFCCP.Main outcome measuresClinical outcome measures from secondary care records.ResultsThe sensitivity and specificity of the YFCCP are 0.94 (0.85 to 0.98) and 0.92 (0.90 to 0.94), giving a negative and positive predictive value of 0.99 (0.98 to 1.0) and 0.51 (0.43 to 0.59), respectively.ConclusionsThe YFCCP overcomes the challenges experienced with FC use in primary care, its efficacy matching initial NICE projections. It is readily incorporated into clinical practice. It should represent the framework on which to increase NICE DG11 implementation nationally.

Editorial Volume 17 Issue 2

2018 ◽  
Vol 17 (2) ◽  
pp. 59-59
Author(s):  
Tim Cooksley ◽  
◽  
Ben Lovell ◽  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Quality Improvement ◽  
Elderly Patients ◽  
Acute Care ◽  
Quality Improvement Project ◽  
Model Of Care ◽  
Improvement Project ◽  
Acute Medicine ◽  
The Uk

As those working in Acute Medicine gather at SAMsterDAM2, the spring conference of the Society for Acute Medicine, the growth, reputation and global representation of the specialty continues to grow. Alongside, the traditional strongholds of the UK, Ireland, Netherlands, Denmark and Australia growth in Asia continues with an AMU now established in Pakistan among other countries. The global growth and interest in Acute Medicine is reflected in this issue of the journal, in which we are delighted to have a truly international cohort of authors. The papers in this issue add to the understanding of some of the fundamental tenets of the specialty key to delivering high quality acute medical care, including international adaptation of the AMU model of care, the Acute Medicine/Primary Care interface, the referral of older patients to Critical Care, readmissions and a reminder of the opportunities an acute medical admission presents to perform important health screening interventions. Rombach et al. describe the impact of implementing an AMU model of care in Amsterdam. The results of the first four years of the model mirror those seen following their introduction in the UK with improved patient flow and reduced length of stay with no effect on readmission rates. The crucial topic of trying to ensure and describe optimal transfer of clinical information between the Acute Medicine and Primary Care interface is addressed through a quality improvement project by Lockman et al. with an accompanying editorial by Professor Dan Lasserson. Their success highlights the opportunities to drive quality through multi-specialty working and innovative thinking. Nannan-Panday et al. examine the vital sign changes in readmitted patients. They describe that deterioration in key physiological signs is common in patients with unplanned readmissions and suggest early intervention through wearable technologies may be a strategy for reducing this adverse event. Bosch et al. retrospectively analyse the outcomes of elderly patients admitted to Intensive Care directly from the Emergency Department compared to those admitted from general wards finding the former group have better outcomes. This reinforces the importance of early decision making, particularly in elderly patients, so fundamental to the practice of Acute Medicine. Rice et al. report the results of a quality improvement project focusing on HIV testing in their Emergency Department at the world’s largest cancer hospital. They reflect that acute care specialties are uniquely positioned to influence clinical practice because of the large cross section of patients for whom it supports. As we as Acute Medicine practitioners reflect on what we are achieving and what there is to accomplish, we need to remind ourselves that the global footstep of our specialty is increasing and we have the opportunity to imprint its principles further in the acute care of medical patients.

Society for Acute Medicine Benchmarking Audit 2019 (SAMBA19): Trends in Acute Medical Care

2020 ◽  
Vol 19 (4) ◽  
pp. 209-219
Author(s):  
Mark Holland ◽  
◽  
Christian Subbe ◽  
Cat Atkin ◽  
Thomas Knight ◽  
...  
Keyword(s):  
Medical Care ◽  
Clinical Decision ◽  
Early Warning Score ◽  
Acute Medicine ◽  
Patient Level ◽  
Discharge Rates ◽  
Sample Frequency ◽  
The Uk ◽  
The Impact ◽  
Acute Medical Care

Introduction: The eighth Society for Acute Medicine Benchmarking Audit (SAMBA19) took place on Thursday 27th June 2019. SAMBA gives a broad picture of acute medical care in the UK and allows individual units to compare their performance against their peers. Method: All UK hospitals were invited to participate. Unit and patient level were collected. Data were analysed against published Clinical Quality indicators (CQI) and standards. This was the biggest SAMBA to date, with data from 7170 patients across 142 units in 140 hospitals. Results: 84.5% of patients had an Early Warning Score measured within 30 minutes of arrival in hospital (SAMBA18 84.1%), 90.4% of patients were seen by a competent clinical decision maker within four hours of arrival in hospital (SAMBA18 91.4 %) and 68.6% of patients were seen by a consultant within the timeframe standard (SAMBA18 62.7%). Ambulatory Emergency Care is provided in 99.3% of hospitals. 61.8% of patients are initially seen in the Emergency Department (ED). Since SAMBA18 death rates and planned discharge rates, while the use of NEWS2 increased from 2.5% to 59.2% of hospitals. Conclusion: SAMBA19 highlighted the evolving complexity of acute medical pathways for patients. The challenge now is to increase sample frequency, assess the impact of SAMBA open a broader debate to define optimal CQIs.

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