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.

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.

Editorial

2009 ◽  
Vol 8 (1) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Editorial Team ◽  
Political Agenda ◽  
Ageing Population ◽  
Demographic Shift ◽  
Letters To The Editor ◽  
Escape Route ◽  
Acute Medicine ◽  
Large Numbers ◽  
The Uk ◽  
The Impact

Milestones are often seen as opportunities for reflection and reminiscence. As this edition of the journal coincides with the 10th anniversary of my consultant appointment I hope readers will forgive a couple of paragraphs of self-indulgence. The phrase: ‘Where did all that time go?’ will probably be familiar to physicians at a more advanced stage of their career. With medical students now returning as specialist registrars, and former house officers appearing as consultant colleagues, the passage of time is increasingly apparent. I recently realised that our current third year students were born in the year I clerked my first patient: surprisingly I still remember his name, age and diagnosis, unlike many of those (and all of the students!) who I have seen since. On a more positive note, there have clearly been a lot of changes over these ten years: at the time of my appointment in June 1999 there was just a small handful of ‘acute physicians’ in the UK. SAM meetings attracted barely 100 delegates, despite providing free admission, and most of us had planned our escape route in case the acute medicine concept went ‘belly-up’ before our retirement. Now, with several hundred acute medicine consultants, similar numbers of trainees, and ‘full speciality’ status rapidly approaching, job security should no longer be a major concern. Indeed, the last 12 months has seen a further considerable expansion of the speciality; all of the first cohort of acute medicine trainees in Wessex have secured consultant positions, and I am told that SAM now has close to 700 full members. What the next ten years will bring remains to be seen, but with an ageing population and year-round pressures from rising emergency admissions, acute medicine will surely continue to strengthen. As I indicated last time, an increasing number of research-based submissions will be trickling into the journal over the next few editions. The impact of alcohol on the Health Service is a subject which has been at the top of the political agenda in recent months. So it is timely to include an article highlighting its impact on the Acute Medical intake in a busy Teaching hospital in this edition of the journal. The finding that one-in-five patients admitted to the AMU were considered ‘hazardous’ drinkers will probably come as no surprise to acute physicians working elsewhere in the UK. In fact this figure may have been an under-estimate given that the number of units consumer per week was not documented in 30% of clerking records. The demographic shift away from the stereotype ‘middle-aged male’ drinker is also apparent with large numbers of females aged 40-59 falling into this category. Recent editions of this journal would not seem complete without mention of training in practical procedures. In this issue the SAM trainee representatives have summarised the recent trainee survey in this area, providing some recommendations which will hopefully be incorporated into the new curriculum. Readers who are becoming tired of this subject can be reassured that this should be the final article relating to this for the time being! I hope this edition provides interesting reading and please keep the submissions coming – although the review articles are usually solicited by the editorial team, we will continue to consider any submitted article for publication, provided there is a clear teaching message for those working in the field of Acute Medicine. Any feedback on the articles included in this or previous editions would also be welcome, and may be included in a future ‘viewpoint’ or ‘letters to the editor’ section.

scholarly journals QOLP-03. MEASURING CHANGE IN HEALTH-RELATED QUALITY OF LIFE: THE ADDED VALUE OF ANALYSIS ON THE INDIVIDUAL PATIENT LEVEL IN GLIOMA PATIENTS IN CLINICAL DECISION MAKING

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi197-vi198 ◽  
Author(s):  
Marijke Coomans ◽  
Martin Taphoorn ◽  
Neil Aaronson ◽  
Brigitta Baumert ◽  
Martin van den Bent ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Scale Item ◽  
Individual Patient Level ◽  
Patient Level ◽  
Related Quality ◽  
The Individual ◽  
The Impact ◽  
Over Time

Abstract BACKGROUND: Health-related quality of life (HRQoL) is an important outcome in glioma research, reflecting the impact of disease and treatment on a patient’s functioning and wellbeing. Data on changes in HRQoL scores provide important information for clinical decision-making, but different analytical methods may lead to different interpretations of the impact of treatment on HRQoL. This study aimed to study whether different methods to evaluate change in HRQoL result in different interpretations. Methods: HRQoL and sociodemographical/clinical data from 15 randomized clinical trials were combined. Change in HRQoL scores was analyzed: (1)at the group level, comparing mean changes in scale/item scores between treatment arms over time, (2)at the patient level per scale/item by calculating the percentage of patients that deteriorated, improved or remained stable on a scale/item per scale/item, and (3)at the individual patient level combining all scales/items. Results: Data were available for 3727 patients. At the group scale/item level (method 1), only the item ‘hair loss’ showed a significant and clinically relevant change (i.e. ≥10 points) over time, whereas change scores on the other scales/items showed a statistically significant change only (all p< .001, range in change score:0.1–6.2). Analyses on the patient level per scale (method 2) indicated that, while a large proportion of patients had stable HRQoL over time (range:27–84%), many patients deteriorated (range:6–43%) or improved (range:8–32%) on a specific scale/item. At the individual patient level (method 3), the majority of patients (86%) showed both deterioration and improvement, while only 1% of the patients remained stable on all scales. Conclusion: Different analytical methods of changes in HRQoL result in distinct interpretations of treatment effects, all of which may be relevant for clinical decision-making. Additional information about the joint impact of treatment on all outcomes may help patients and physicians to make the best treatment decision.

scholarly journals OS7.2 Measuring change in health-related quality of life: the added value of analysis on the individual patient level in glioma patients in clinical decision making

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii14-iii14
Author(s):  
M Coomans ◽  
M J B Taphoorn ◽  
N Aaronson ◽  
B G Baumert ◽  
M van den Bent ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Scale Item ◽  
Individual Patient Level ◽  
Patient Level ◽  
Related Quality ◽  
The Individual ◽  
The Impact ◽  
Over Time

Abstract BACKGROUND Health-related quality of life (HRQoL) is often used as an outcome in glioma research, reflecting the impact of disease and treatment on a patient’s functioning and wellbeing. Data on changes in HRQoL scores may provide important information for clinical decision-making, but different analytical methods may lead to different interpretations of the impact of treatment on HRQoL. This study aimed to examine three different methods to evaluate change in HRQoL, and to study whether these methods result in different interpretations. MATERIAL AND METHODS HRQoL and sociodemographical/clinical data from 15 randomized clinical trials were combined. Change in HRQoL scores was analyzed in three ways: (1) at the group level, comparing mean changes in scale/item scores between treatment arms over time, (2) at the patient level per scale/item by calculating the percentage of patients that deteriorated, improved or remained stable on a scale/item per scale/item, and (3) at the individual patient level combining all scales/items. RESULTS Baseline and first follow-up HRQoL data were available for 3727 patients. At the group scale/item level (method 1), only the item ‘hair loss’ showed a significant and clinically relevant change (i.e. ≥10 points) over time, whereas change scores on the other scales/items showed a statistically significant change only (all p<.001, range in change score: 0.1–6.2). Analyses on the patient level per scale (method 2) indicated that, while a large proportion of patients had stable HRQoL over time (range 27–84%), many patients deteriorated (range: 6–43%) or improved (range: 8–32%) on a specific scale/item. At the individual patient level (method 3), the majority of patients (86%) showed both deterioration and improvement, while only 1% of the patients remained stable on all scales. Clustering on clinical characteristics (WHO performance status, sex, tumor type, type of resection, newly diagnosed versus recurrent tumor and age) did not identify subgroups of patients with a specific pattern of change in their HRQoL score. CONCLUSION Different analytical methods of changes in HRQoL result in distinct interpretations of treatment effects, all of which may be relevant for clinical decision-making. Additional information about the joint impact of treatment on all outcomes, showing that most patients experience both deterioration and improvement, may help patients and physicians to make the best treatment decision.

THE VALUE OF IN VITRO DIAGNOSTIC TESTING IN THE PROVISION OF MEDICAL CARE TO ELDERLY PATIENTS WITH CARDIOVASCULAR DISEASES

2020 ◽  
Vol 65 (3) ◽  
pp. 191-196
Author(s):  
A. S. Pushkin ◽  
O. V. Lyang ◽  
T. A. Ahmedov ◽  
S. A. Rukavishnikova
Keyword(s):  
Decision Making ◽  
Medical Care ◽  
Laboratory Tests ◽  
Clinical Decision Making ◽  
Diagnostic Testing ◽  
Clinical Decision ◽  
Initial Examination ◽  
Attending Physicians ◽  
The Impact

In vitro diagnostics are used at all stages of patient care. The aim of this study was to assess the impact of laboratory examination on clinical decision-making in providing medical care to patients with a cardiovascular profile. We also took into account the level of financing for the laboratory industry in the Russian Federation. We divided our study on three sequential steps: literature review, survey of clinicians and test-survey of clinicians. The share of costs for the laboratory tests in 2017 amounted to about 8% of the total funding for Russian health care. About 80% (70; 90) of the visits of the attending physicians are associated with the appointment of laboratory tests. Among patients who were prescribed any laboratory test - in 62.1% (95% CI 16.9-24.9) cases, the results of these tests influenced clinical decision making related to the initiation, modification or termination of any treatment. All visits of clinicians were divided by purpose: tests were prescribed in almost 100% (90; 100) cases during the initial examination, in 40% (20; 60) cases during repeated visits, and in 40% (15; 40) cases when patients were examined before discharge. In more than half of cases (57,4%; n=31), doctors correctly assumed about the about the share of financing of the laboratory industry. The majority of respondents considered the amount of expenses adequate and recommended to maintain the current level in the future. According to attending physicians, new laboratory markers should demonstrate additional information about clinical relevance to improve patient outcomes. Thus, in current economic realities, future laboratory tests should be financially maximally available and at the same time be clinically highly effective auxiliary instruments. It creates new challenges in finding laboratory biomarkers and putting them into clinical practice.

scholarly journals Study protocol for COvid-19 Vascular sERvice (COVER) study: The impact of the COVID-19 pandemic on the provision, practice and outcomes of vascular surgery

2020 ◽  
Author(s):  
Ruth A Benson
Keyword(s):  
Vascular Surgery ◽  
Service Provision ◽  
British Society ◽  
Tier 2 ◽  
Patient Level ◽  
Tier 1 ◽  
Ethical Approval ◽  
The Uk ◽  
Tier 3 ◽  
The Impact

ABSTRACTBackgroundThe novel Coronavirus Disease 2019 (COVID-19) pandemic is having a profound impact on global healthcare. Shortages in staff, operating theatre space and intensive care beds has led to a significant reduction in the provision of surgical care. Even vascular surgery, often insulated from resource scarcity due to its status as an urgent specialty, has limited capacity due to the pandemic. Furthermore, many vascular surgical patients are elderly with multiple comorbidities putting them at increased risk of COVID-19 and its complications. There is an urgent need to investigate the impact on patients presenting to vascular surgeons during the COVID-19 pandemic.Methods and AnalysisThe COvid-19 Vascular sERvice (COVER) study has been designed to investigate the worldwide impact of the COVID-19 pandemic on vascular surgery, at both service provision and individual patient level. COVER is running as a collaborative study through the Vascular and Endovascular Research Network (VERN) with the support of numerous national (Vascular Society of Great Britain and Ireland, British Society of Endovascular Therapy, British Society of Interventional Radiology, Rouleaux Club) and an evolving number of international organisations (Vascupedia, SingVasc, Audible Bleeding (USA), Australian and New Zealand Vascular Trials Network (ANZVTN)). The study has 3 ‘Tiers’: Tier 1 is a survey of vascular surgeons to capture longitudinal changes to the provision of vascular services within their hospital; Tier 2 captures data on vascular and endovascular procedures performed during the pandemic; and Tier 3 will capture any deviations to patient management strategies from prepandemic best practice. Data submission and collection will be electronic using online survey tools (Tier 1: SurveyMonkey® for service provision data) and encrypted data capture forms (Tiers 2 and 3: REDCap® for patient level data). Tier 1 data will undergo real-time serial analysis to determine longitudinal changes in practice, with country-specific analyses also performed. The analysis of Tier 2 and Tier 3 data will occur on completion of the study as per the prespecified statistical analysis plan.Ethical ApprovalEthical approval from the UK Health Research Authority has been obtained for Tiers 2 and 3 (20/NW/0196 Liverpool Central). Participating centres in the UK will be required to seek local research and development approval. Non-UK centres will need to obtain a research ethics committee or institutional review board approvals in accordance with national and/or local requirements.ISRCTN: 80453162 (https://doi.org/10.1186/ISRCTN80453162)Ethical Approval: 20/NW/0196 Liverpool Central, IRAS: 282224

The impact of SIGN glaucoma guidelines on false-positive referrals from community optometrists in Central Scotland

2018 ◽  
Vol 103 (3) ◽  
pp. 369-373 ◽  
Author(s):  
Samantha Sii ◽  
Ahmad Nasser ◽  
Cheng Yi Loo ◽  
Catherine Croghan ◽  
Alan Rotchford ◽  
...  
Keyword(s):  
Corneal Thickness ◽  
Secondary Outcome ◽  
Visual Field Defects ◽  
Referral Criteria ◽  
Discharge Rates ◽  
Before And After ◽  
Group 2 ◽  
The Uk ◽  
The Impact

BackgroundSince the introduction of National Institute for Health and Care Excellence glaucoma guidelines 2009, the number of referrals from community optometrists to hospital eye services has increased across the UK, resulting in increase in first visit discharge rates (FVDRs).AimTo assess the impact of Scottish Intercollegiate Guidelines Network (SIGN) 144 on quality of referrals from community optometrists.MethodologyA retrospective study of patient records who attended as new adult glaucoma referrals to clinics in Princess Alexandra Eye Pavilion, Edinburgh, and in Greater Glasgow and Clyde, was carried out across October–November 2014 (group 1) and September–October 2016 (group 2), before and after the introduction of SIGN 144. The primary outcome of this study is FVDRs. A secondary outcome is the extent of compliance to referral recommendations by SIGN guidelines.ResultsThree hundred and twelve and 325 patients were included in groups 1 and 2, respectively. There was a significant decline in FVDRs between these two periods from 29.2% to 19.2%. (p=0.004) (OR 0.58 (95%CI 0.40 to 0.84)). Post-SIGN guidelines, 87% of referrals were compliant to SIGN referral criteria while 13% remained non-compliant. The main reasons for non-compliance were no repeatable visual field defects (42.0%) and referrals due to high intraocular pressure were either not repeated or not interpreted in the context of age and central corneal thickness (36.8%).ConclusionPatients referred after the introduction of SIGN guidelines were 33.5% less likely to be discharged at the first visit. Although compliance to most recommendations in SIGN guidelines has improved, there is still a need to improve adherence to referral criteria

scholarly journals Comparative Survey of People with ME/CFS in Italy, Latvia, and the UK: A Report on Behalf of the Socioeconomics Working Group of the European ME/CFS Research Network (EUROMENE)

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 300
Author(s):  
Elenka Brenna ◽  
Diana Araja ◽  
Derek F. H. Pheby
Keyword(s):  
Quality Of Life ◽  
Medical Care ◽  
Social Care ◽  
Research Network ◽  
Comparative Survey ◽  
The Uk ◽  
Household Incomes ◽  
The Impact ◽  
Demographic Features

Background and Objectives: A comparative survey of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients was carried out in three countries, with the aim of identifying appropriate policy measures designed to alleviate the burden of disease both on patients and their families, and also on public institutions. The survey addressed demographic features, the economic impact of the disease on household incomes, patterns of medical and social care, specific therapies, social relationships, and the impact of the illness on quality of life. Materials and Methods: Parallel surveys were undertaken in Italy, Latvia, and the UK. There were 88 completed responses from Italy, 75 from Latvia, and 448 from the UK. To facilitate comparisons, 95% confidence intervals were calculated in respect of responses to questions from all three countries. To explore to what extent general practitioners (GPs) manage ME/CFS disease, a separate questionnaire for GPs, with questions about the criteria for granting a diagnosis, laboratory examinations, the involvement of specialists, and methods of treatment, was undertaken in Latvia, and there were 91 completed responses from GPs. Results: The results are presented in respect of sociodemographic information, household income, disease progression and management, perceived effectiveness of treatment, responsibility for medical care, personal care, difficulty explaining the illness, and quality of life. Demographic details were similar in all three countries, and the impact of illness on net household incomes and quality of life. There were significant differences between the three countries in illness progression and management, which may reflect differences in patterns of health care and in societal attitudes. Graded exercise therapy, practiced in the UK, was found to be universally ineffective. Conclusions: There were similarities between respondents in all three countries in terms of demographic features, the impact of the illness on household incomes and on quality of life, and on difficulties experienced by respondents in discussing their illness with doctors, but also differences in patterns of medical care, availability of social care, and societal attitudes to ME/CFS.

scholarly journals The Team at Work – The Society for Acute Medicine’s Benchmarking Audit 2014 (SAMBA’14)

2015 ◽  
Vol 14 (3) ◽  
pp. 99-103
Author(s):  
Christian P Subbe ◽  
◽  
Ivan Le Jeune ◽  
Caroline Burford ◽  
Rahul S Mudannayake ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Online Survey ◽  
Performance Indicator ◽  
Standard Of Care ◽  
Quality Standards ◽  
Early Warning Score ◽  
Acute Medicine ◽  
Staffing Levels ◽  
And Performance ◽  
The Impact

Background: The Society for Acute Medicine’s Benchmarking Audit (SAMBA) serves as a tool for Acute Medical Units to compare and improve their quality of care. Aim: To audit the performance of Acute Medical Units against clinical quality indicators, standards by the Royal College of Physicians and Specialist Societies relevant to the practice of Acute Medicine. Methods: An online survey of unit profiles and staffing levels on the audit day was followed by a 24-hour data collection on Thursday the 19th of June 2014 for all patients seen by the local Acute Medicine teams as part of the general medical take. Patients were followed-up for 72 hours. We reviewed the impact of staffing levels on performance indicators. Results: 66 Acute Medical Units admitted 2333 patients during the 24-hour period. Compliance with the quality standards of SAM was as follows: 84% of patients had an early warning score recorded within 30 minutes of admission, 81% of patients had been seen by a competent decision maker within four hours and 73% of patients were seen by a consultant physician within the appropriate period of time. Only 56% of patients received a standard of care compatible with all three quality standards. We found no relation between unit characteristics, staffing and performance indicator. Conclusion: There remains a gap between the standard described by the quality indicators and the performance of Acute Medical Units during a one-day audit.

Editorial

2013 ◽  
Vol 12 (2) ◽  
pp. 67-68
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Continuity Of Care ◽  
Early Warning Score ◽  
Initial Assessment ◽  
Similar Proportion ◽  
Published Data ◽  
Acute Medicine ◽  
General Internal ◽  
Acute Medical Unit ◽  
Future Hospital ◽  
The Uk

Much has been written in recent months about the challenges at the hospital’s front door; emergency departments and acute medical units have found themselves in the spotlight, while politicians and clinical leaders have debated where the causes for this crisis lie. As summer progresses and we continue to search for solutions, it is likely that some of the focus will shift from the emergency department to the processes of care which take place after a patient has been admitted. The Royal College of Physicians’ long awaited Future Hospital Commission report will be published later in the year; a key theme in this document is going to be the importance of continuity of care for patients in hospitals, ensuring the minimum numbers of patient transfers both within the hospital and between consultants. Inevitably this will open a key debate over the role of the ‘generalist’ in hospitals of the future. The last decade has seen a steady drift away from generalism, with increasing numbers of hospital clinicians retreating into their speciality enclaves, and withdrawing from the acute medical take. For some patients speciality-led care has been shown to be highly effective; however there remain significant numbers of patients whose problems cannot be neatly packaged into a single organ category. Acute physicians have taken on the management of this group of patients within the acute medical unit (AMU), but who should provide ongoing general medical care for patients who are transferred out of the Unit? A recent survey of members of the Society for Acute Medicine (SAM) has confirmed that the overwhelming majority of existing acute medicine consultants are accredited in General Internal Medicine (GIM), while a similar proportion of current acute medicine trainees expect to attain a certificate of completed training in GIM. Provided that hospitals can secure adequate numbers of new consultant appointments, acute physicians will be ideally placed to provide continuity of care for this patient group. The survey, which will soon be published on the SAM website, also indicates that most acute physicians would be happy to provide this service, as long as it was appropriately resourced and supported; furthermore a substantial proportion viewed a combination of GIM and acute medicine as their preferred model for their future job plan. Inevitably, staffing levels will be key to whether acute physicians can branch out of the AMU. There appears to be no lack of enthusiasm amongst hospitals to expand numbers of acute physicians, with vacancies being advertised on a weekly basis across the UK. However a shortage of doctors completing acute medicine training in 2013, due in part to curriculum changes in 2009, means that many of these posts are remaining unfilled. It is clear that much work clearly remains to be done on our acute medical units to ensure that we achieve the high standards which SAM has published. By the time this edition is published, data for the second Society for Acute Medicine Benchmarking Audit (’SAMBA 2013’) will already have been collected. Results of last year’s baseline audit are presented in this edition, and highlight a number of areas in which acute medical units needed to improve. Delays in the initial assessment of patients and consultant review are likely to have reflected the well recognised, and ongoing imbalance between demand and workforce; however it is encouraging to note that almost all patients underwent appropriate observations to enable calculation of an early warning score. Access to investigations for pulmonary embolism and upper gastrointestinal bleeding also appeared to be constrained to a greater degree than CT scan for suspected stroke, which may reflect the relative priorities often afforded to these conditions. It should be noted that the data were collected on a Wednesday – weekend access to investigations remains an even greater challenge in many centres. Those who are regular users of Twitter and other social media will no doubt be aware of their increasing range of medical uses. In the third of a triad of articles which this journal has published on sepsis, Luke McMenemin and colleagues have highlighted how Twitter might be used in future to help disseminate and identify innovative medical solutions to common clinical challenges. Delays in the publication of traditional written media mean that broad implementation sometimes lags behind the innovation; as a consequence, there may be a tendency to ‘reinvent the wheel’ rather than learning from others’ experience. Twitter clearly has its limitations – the 140 character limit is a tough ask for even the most succinct of writers – but with an increasing numbers of users, perhaps the time has come for more acute physicians to take the plunge!

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