Hospital mortality has been a hot topic in the medical and popular Press over recent years. Many readers will recall ‘scandals’ around hospitals whose mortality rates appeared higher than that which would be expected. The so-called ‘weekend effect’ whereby patients admitted to hospital between Friday and Monday appear more likely to die during their hospital stay has been regularly quoted in Parliament by the Secretary of State as justification for the Government’s manifesto pledge to create a ‘7 day NHS’. A number of recent publications have illustrated the complexity of this statistic, which – at least in part – is likely to reflect illness severity as much as organizational factors. The paper by Emma Mason in this edition further supports the concept that hospital mortality statistics may be hard to influence through structural or staffing changes. Those working in the acute medicine setting will not be surprised to read that almost half of those patients who die within 48 hours of arrival in hospital had solely palliative care needs at the time of admission. Many of these patients were elderly, frail and resident in a care home environment, but many also had undergone previous admissions within the months leading up to their death; the authors comment that this could have provided an opportunity to discuss end of life care plans, potentially enabling their final admission to hospital to have been avoided. Preventing ‘avoidable’ deaths in hospital from conditions such as sepsis and acute pulmonary embolism is a key component of the job of an acute physician. However, even when death in unavoidable we must do what we can to ensure patients die in the environment of their choice. Reducing deaths in hospital should not simply focus on those whose death can be prevented.
Although mortality statistics may be misleading when interpreted in isolation, good quality data can be a powerful tool to influence changes in the acute medicine setting. By the time this edition is published, the 2016 Society for Acute Medicine Benchmarking Audit (SAMBA16) will already have take n place; previous years’ data were published in this journal and we hope to see a continued rise in the numbers of participating units this year. Tom Brougham and colleagues from Bristol have illustrated how an electronic system for data collection on their AMU enabled reorganization of their junior doctor rota, reducing waiting time for patients. Their data illustrate the problem which will be familiar to many acute physicians, whereby the surge in afternoon arrivals on the AMU often coincides with shift changeovers and reductions in junior doctor and other numbers. Matching staffing to workload can have significant benefits for patient care and may enable a reduced strain on the night shift team if patients are seen in a more timely fashion. Whether this can be linked to improved patient outcomes in the future will be interesting.
Finally, I would like to welcome one more addition to the editorial board. Dr Nick Murch is an acute physician in the Royal Free hospital, with an interest in medical education and simulation skills training. With an increasing number of acute medicine trainees undertaking medical education as their specialist skill, I am keen to develop the training and education section of the journal over the coming years, and look forward to Nick’s input in this regard. We will continue to welcome submissions of research relating to acute medicine education and training, which we will consider for future publication in this section of the journal.