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Editorial Volume 17 Issue 1

Delivering and transforming, but many questions and challenges remain

Acute Medicine remains a specialty in its infancy and, as such, faces many challenges associated with developing new ways of working. As the Society for Acute Medicine celebrates its 18th birthday the extraordinary role of Acute Medicine in both maintaining and indeed enhancing the care and welfare of patients is increasingly evident. However, scepticism still persists among some colleagues with regards to its effectiveness – a perception heightened by the difficult environment that currently pervades in acute and emergency care in the UK which mirrors the experience of many countries internationally.

A reasoned and cogent reflection of the impact of Acute Medicine over the last decade necessitates a conclusion that much has been achieved and the infrastructure is in place to ensure future innovative, high quality and adaptive acute medical care. Early international adopters of the specialty demonstrate its increasing traction. A vision of how the struggling UK acute care sector would have survived without Acute Medicine, Acute Medical Units and the “front door” models led by the specialty is not appealing.

Acute Medicine reflects all of medicine with its rapid change, development and improvement. The need for specialists in acute medical care on this background is self-explanatory. Reliance on physicians performing this role episodically, occasionally reticently, and in addition to their own specialty is not ideal.

The evidence for Acute Medicine is growing. However, even its most ardent supporter would struggle to argue that sufficient progress has been made in the research aspect of the specialty but undoubtedly the foundations are being established. It is a tremendous privilege to take over from Dr Chris Roseveare as editor of this journal. His commitment and passion for Acute Medicine is inspiring. His achievement in getting the journal listed on PubMed cannot be understated, facilitating breakthrough studies and laying the foundations for landmark Acute Medicine research. His boots will be extremely hard to fill as the journal strives to become the pre-eminent international Acute Medicine journal.

SAMBA, the Society for Acute Medicine’s Benchmarking Audit, initially focused on the society’s key quality indicators, has flourished and evolved to analyse other fundamental aspects of acute medical care.

There has been rapid expansion both in terms of participating AMUs and patient numbers with an expectation and desire that SAMBA will continue to grow incorporating international involvement as countries adopt the model of Acute Medicine. SAMBA not only benchmarks performance but can guide the development of future clinical quality measures in the UK and set international standards of acute medical care, an iterative process which benefits patients care.

Acute Medicine research groups are developing. A European group of Acute Physicians, Safer@home, last year published the CURIOS@, a prospective observational study examining readmissions. Multiple national and regional groups are starting to produce high quality innovation projects and research output.

Acute Physicians are also leading high impact multinational interventional studies. The PHANTASi study, whose protocol was published in Acute Medicine, was a randomised controlled open-label trial which studied the impact of early antibiotic administration by paramedics in patients with sepsis. PHANTASi concluded that whilst training paramedics improved recognition, giving antibiotics in the ambulance did not improve survival irrespective of the severity of sepsis.

The opportunities and appetite for Acute Medicine studies that will be practice changing is irresistible and must be grasped to further embed the specialty.

In this issue of Acute Medicine, Byrne et al. examine a clinical risk score in 86,413 acute medical episodes over a 15 year period. They identified four distinct cluster groups based on the score which may assist Acute Physicians in framing decisions regarding risk and prognostication. In a further paper considering prognostication in acute medical patients, Soltau et al report the significance of white cell count.

Respiratory rate is a key physiological variable in many acute medical emergencies, but is often poorly measured and this has led to much interest into the development wearable and non-wearable technology for continuous respiratory rate monitoring. Subbe at al. report a prospective observational study of automated respiratory rate measurements compared with manual recording. They conclude that electronic recordings appear to give more accurate results. Whether this will facilitate earlier recognition of the deteriorating patient on Acute Medical Units in clinical practice needs to be studied.

Physical inactivity is known to be associated with higher levels of morbidity and mortality. NICE recommends brief advice in primary care with the aim of improving physical activity. Murphy and Le Jeune report the results of a quantitative study showing that patients may be receptive to receiving health promotion advice related to physical activity during an acute medical admission. This paper reinforces that AMUs are potentially a great resource for driving key public health messages.

The specialty of Acute Medicine is making extraordinary efforts to improve the care of acutely unwell patients. We hope this journal continues to educate and interest all its practitioners.

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