Abstract

An Acute Medical Unit has recently been established at York Hospital. The present study sought to characterise the case mix of acutely unwell medical patients to allow identification of priorities for ongoing service development and to assess educational opportunities for trainees in the region. Data were collected for 16001 admission episodes between January 2010 and April 2011 inclusive. These allowed characterisation of the case mix, and identified key priorities where clinical pathway do not yet exist, namely heart failure, urinary tract infection, and acute diarrhoea. Good educational opportunities exist for most aspects of the Acute Medicine curriculum; several weaknesses were identified, and trainees might address these by undertaking a specific period of specialty training in endocrinology and neurology.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Ahmed SV, Jayawarna C, Atkinson D et al. Following National Guidelines in Acute Care can improve emergency access and patient flow. Acute Med. 2010; 9: 114-7.
2. Crosswaite AG, Dougall H, Duguid I et al. Providing better care for patients with complex needs in acute medicine. Acute Med. 2009; 8: 80-4.
3. McNeill GB, Brand C, Clark K, et al. Optimizing care for acute medical patients: the Australasian Medical Assessment Unit Survey. Intern Med J. 2011; 41: 19-26.
4. Vearncombe L. Acute Medicine: A Practical guide to the management of medical emergencies. Acute Med. 2008; 7: 141.
5. Beckett DJ, Raby E, Pal S, et al. Improvement in time to treatment following establishment of a dedicated medical admissions unit. Emerg Med J. 2009; 26: 878-80.
6. Evans K, Fulton B. Meeting the challenges of Acute Care Quality Indicators. Acute Med. 2011; 10: 91-4.
7. McCallum L, Bell D, Sturgess I, et al. National ambulatory emergency care survey: current level of adoption and considerations for the future. Clin Med. 2010; 10: 555-9.
8. Roseveare CD. Setting new standards for acute care the society for acute medicine international conference, 1-2 october 2007. Acute Med. 2007; 6: 85-6.
9. Subbe CP, Bottle RA, Bell D. Acute Medicine: triage, timing and teaching in the context of medical emergency admissions. Eur J Intern Med. 2011; 22: 339-43.
10. MRCPUK Membership of the Royal Colleges of Physicians of the United Kingdom. Specialty Certificate Examination in Acute Medicine. www.mrcpuk.org/SCE/Specialties/Pages/AcuteMedicine.aspx (accessed 03rd January 2012).
11. Martin S, Smith P. Explaining variations in inpatient length of stay in the National Health Service. J Health Econ. 1996; 15: 279-304.
12. Hospital Episode Statistics. Available online at http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=203 (accessed 03rd January 2012).
13. Mooney ED, Bennett K, Silke B. Length of hospital stay, diagnoses and pattern of investigation following emergency admission to an Irish teaching hospital. Ir Med J. 2004; 97: 170-2.
14. Roger D, Runolfur P, Lenka B, et al. Common diagnoses in internal medicine in Europe 2009: a pan-European, multi-centre survey. Eur J Intern Med. 2010; 21: 449-52.
15. Heuer JF, Gruschka D, Crozier TA, et al. Accuracy of prehospital diagnoses by emergency physicians: comparison with discharge diagnosis. Eur J Emerg Med. 2011. Epub ahead of print
16. Perry JJ, Stiell IG, Sivilotti ML, et al. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ. 2011; 343: d4277.
17. Waring WS, Robinson OD, Stephen AF, et al. Does the patient history predict hepatotoxicity after acute paracetamol overdose? QJM. 2008; 101: 121-5.
18. Khadjooi K, Dimopoulos C, Paterson J. The acute physicians unit in Scarborough hospital. Acute Med. 2009; 8: 132-5.
19. Close JC, Lord SR, Antonova EJ, et al. Older people presenting to the emergency department after a fall: a population with substantial recurrent healthcare use. Emerg Med J. 2011. Epub ahead of print.
20. Purdy S, Griffin T, Salisbury C, et al. Emergency respiratory admissions: influence of practice, population and hospital factors. J Health Serv Res Policy. 2011; 16: 133-40.
21. Southgate J, Ruparelia P, Phillips S. The acute medicine - speciality interface: experience in a large teaching hospital. Acute Med. 2011; 10: 85-8.
22. Cannon C. The acute medicine - speciality interface: experience in a district general hospital. Acute Med. 2011; 10: 89-90.
23. Neuman MD, Speck RM, Karlawish JH, et al. Hospital protocols for the inpatient care of older adults: results from a statewide survey. J Am Geriatr Soc. 2010; 58: 1959-64.
24. Ala L, Hughes T. Where there is no resident neurologist: a case for a neurology attachment for acute medicine trainees. Clin Med. 2011; 11: 204-5.
25. National Institute for Health and Clinical Excellence. Admission of patients with suspected stroke. http://www.nice.org.uk/guidance/ qualitystandards/stroke/admissionofpatientswithsuspectedstroke.jsp (accessed 03rd January 2012).
26. Doak MW, Nixon AC, Lupton DJ, et al. Self-poisoning in older adults: patterns of drug ingestion and clinical outcomes. Age Ageing. 2009; 38: 407-11.
27. Russo CA, Elixhauser A. Hospitalizations for Alcohol Abuse Disorders, 2003: Statistical Brief #4. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Health Care Policy and Research (US); 2006 Feb - 2006 May.
28. Waring WS, McGettigan P. Clinical toxicology and drug regulation: a United Kingdom perspective. Clin Toxicol. 2011; 49:452-6.
29. Thanacoody HK, Good AM, Waring WS, et al. Survey of cases of paracetamol overdose in the UK referred to National Poisons Information Service (NPIS) consultants. Emerg Med J. 2008; 25:140-3.
30. Centers for Disease Control and Prevention (CDC). Drug overdose deaths: Florida, 2003-2009. MMWR Morb Mortal Wkly Rep. 2011; 60: 869-72.