Readmissions to hospital have been a hot political issue for several years. Most of us working in acute medicine will have managed patients who – with hindsight – should have stayed in hospital a bit longer. Pressures to shorten length of stay, as a result of rising admissions combined with reduced hospital bed numbers over the past two decades have inevitably contributed to this. The rhetoric of blame implied by the terminology of ‘failed discharge’ is unhelpful, but emphasises the need for vigilance in discharge planning. Financial penalties levied on hospitals for exceeding negotiated levels of readmission, combined with their use as quality indicators for acute medical units keeps this high up in the priority list for physicians and managers. However there is another side to this. For many patients, readmission is a consequence of their disease process, rather than a failure of clinical care. The timing of discharge for patients with frailty, chronic or terminal disease requires a complex balance to be struck – readmission may sometimes be avoidable by keeping a patient in hospital for longer, but this is not always what the patient wants. The article in this edition by Tim Cooksley and colleagues highlights this issue in a specific group of patients with cancer. Their conclusion is that, in this patient group, readmission to hospital is not a useful quality indicator. Although the study was conducted in a tertiary cancer care unit, the key messages are of relevance to those working in general acute medical units, where patients with cancer often represent a significant proportion of admissions. Furthermore the article mentions some interesting innovations, such as a telephone ‘hotline’, which may be of benefit to other groups of patients managed in the acute medicine setting.

This edition features a number of articles relating to the roles of junior doctors on the acute medical unit. The Acute Medicine trainee survey demonstrates that ‘variety’ is still one of the main attractions of the speciality, with over 75% of respondents indicating that this is one of the aspects that they most enjoyed about their training. However there is clearly much more work to be done to encourage more trainees to choose acute medicine as their career. One way to increase recruitment may be to improve the experience for foundation and core medical trainees on the AMU – the article by Eirini Kafsiki suggests that administrative tasks may be impacting on training time for this key group of junior doctors. The authors identify some solutions which have been applied locally, while Nicola Cooper’s viewpoint article explains how we might change perceptions of what constitutes ‘training’ on the AMU.

Finally I am delighted that we have been able to publish the abstracts of the excellent oral presentations at the recent Society for Acute Medicine meeting in Bristol. Those who attended will be aware that this conference was also my final meeting as part of the SAM council, as my tenure has now come to an end. I would like to wish the conference committee well in their planning for the autumn meeting in Manchester on 10th-11th September, which is shaping up to be another great event. Hope to see you all there!


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Trainee Update March 2015

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