As another winter season passes, many colleagues will continue to be working under immense pressures striving to provide high quality care for increasingly larger numbers of patients. The work of Acute Medicine teams to keep the “front door” safe are fundamental to the delivery and sustainability of acute care services. The challenges of innovating and enacting positive changes at times of such high service demand are not insignificant; but the specialty is blessed with rapidly expanding driven and dedicated international, national and local leaders.

The first winter SAMBA has recently been performed. SAMBA is an increasingly rich data source that will serve both nationally and locally to help improve performance and ultimately patient outcomes.¹ Higher quality Acute Medicine is being produced. Acute Physicians are leading in many acute sub-specialties. Pleasingly, there has a been a significant rise in the number of trainees applying to train in Acute Medicine in the UK reflecting the traction the specialty is achieving.

Ambulatory care remains a fundamental tenet to the sustainability of acute care services. Point of care testing is a key element in driving efficient performance in this setting and in this issue Verbakel et al. perform an important analysis on the reliability of point of care testing to support community based ambulatory care.² This work should field the way for further research defining the impact of point of care testing and how it should be implemented in ambulatory clinical practice.

The performance of respiratory rate observation remains poorly performed in acute care settings despite its well validated predictive value. Nakitende et al. describe an app that allows respiratory rate to calculated more quickly and accurately by using a touch screen method.³ Technological innovations to improve the recording and accuracy of physiological parameters in acute care, which can also be used in resource poor settings, will be a focus of large quantities of research in the upcoming years.

Blessing et al. describe an important modelling study on the impact of integrated radiology units.⁴ Co-ordination between Acute Medicine and Radiology departments is essential in a high functioning AMU, especially as increasingly Acute Physicians are trained in point of care ultrasound.

Lees-Deutsch et al. provide a fascinating insight into the patient’s perspective of discharge lounges.⁵ Often used to help maintain flow through the hospital, they elucidate that patients and caregivers transferred from AMU do not find this aspect of their journey a positive one. In times of significant organisational pressures, it is important that clinicians continue to examine the impact of flow measures on the quality of patient care and experience.

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References

1. Lasserson DS, Subbe C, Cooksley T, Holland M. SAMBA18 Report – A National Audit of Acute Medical Care in the UK. Acute Med 2019; 18(2): 76-87.
2. Verbakel JY, Richardson C, Elias T et al. Clinical reliability of point-of-care tests to support community based acute ambulatory care. Acute Med 2020; 19(1): 4-13.
3. Nakitende I, Namujwiga T, Dunsmuir D et al. Respiratory rates observed over 15 seconds compared with rates measured using the RRate app. Practice-based evidence from an observational study of acutely ill adult medical patients during their hospital admission. Acute Med 2020; 19(1): 14-19.
4. Blessing KF, Brabrand M, Graumann O et al. Can the examination time in CT and conventional x-ray be reduced in an emergency department with integrated radiology unit? A retrospective study. Acute Med 2020; 19(1): 20-24.
5. Lees-Deutsch L, Gough B, Yorke J, Caress AL. Patient and Caregiver Experience of Hospital Discharge from an Acute Medical Unit via the Discharge Lounge: A Qualitative Case Study. Acute Med 2020; 19(1): 25-32.