Recently I had to have a few minutes in my office to regroup after I’d seen a patient. I didn’t quite know how to process my feelings. I was feeling ashamed and upset. My patient had been in our waiting room for over 18 hours. He was a bilateral amputee and a wheelchair user. His […]
Guest Editorial – Moral injury in acute medicine Read More
The advent of the SARS-CoV-2 pandemic brought unprecedented challenges to healthcare systems worldwide. As the virus spread across continents, hospitals faced a surge in patient admissions, particularly to intensive care units (ICUs). Understanding the impact of the pandemic on the sickest patients admitted to hospital is crucial for enhancing preparedness for future outbreaks. In this edition of the journal, authors from Denmark report on a register-based national observational study that sheds light on the changes in ICU admission rates and demographic profiles of patients during the initial phase of the pandemic.
Emergency departments are under year-round pressure, driven by high hospital bed occupancy and compounded by increasing attendances and admissions.1 In 2023, 1.5 million people waited 12 hours or more for a bed.2 Long waits are associated with increased mortality and there is a disproportionate impact on people living in more deprived areas.3,4 Addressing this problem begins with unity of purpose and vision, such that we all view emergency department performance as our responsibility, whatever our place in the healthcare system.
Guest Editorial – Ambulatory Care: Turning Urgent and Emergency Care inside out Read More
Despite still being seen as a relatively ‘new’ specialty, Acute Internal Medicine (AIM) has reached full adulthood, with its 23rd birthday being celebrated in 2023, and as a new specialty it is somewhat apt that it’s the same age as the new millennium. Arguably, the coming of age of the specialty has been its role in helping deal with the increased pressures on the urgent and emergency care system, not least with Covid pandemic. However, AIM still faces challenges in its implementation in certain areas. The specialty continues to innovate with regards to service development including Same Day Emergency Care (SDEC), a new Higher Specialty Training curriculum1 including innovations such as mandatory Point of Care Ultrasound (POCUS) as well as the guidance for Enhanced Care Units (ECUs)2 allowing centralised care for those patients needing closer monitoring and specialized care.
Guest Editorial – Acute Medicine Curriculum: “Pulling everything together” Read More
Pulmonary embolism (PE) is a common and potentially life-threatening condition encountered routinely in acute care. The diagnosis and management of PE has been the topic of National Institute of Health Care Excellence and European Cardiology Society guidelines.
Guest Editorial – Pulmonary Embolism: the risk of what we don’t yet know! Read More
Critical Care Units provide care to those patients who traditionally need “organ support”. There is variation in provision and “admission criteria” across the UK, and although Level 2 admissions have been increasing this often reflects increasing perioperative demand and largely ignores the unmet and often unmeasured medical need.
Guest Editorial – Enhanced Care: Developing the resource within Acute Medicine Read More
COVID-19, the eternal hospital winter, heatwaves, global warming, energy costs, inflation, and an unnecessary war. We truly do live in uncertain times. That said, we would wager our grandparents said the same thing. What gets us through is family, friends and out shared communities, including acute medicine. Which brings us to this edition of the journal, where many excellent articles will hopefully distract our reader from all the doom and gloom, and instead light up your grey cells.
Guest Editorial – Curry clubs, uncertain times, and social media Read More
The Nobel-winning physicist Niels Bohr famously said that “prediction is very difficult, especially if it’s about the future.” Nevertheless, the prediction of rapid clinical deterioration has acquired its place in Acute Medicine. Time-urgent medical emergencies can benefit significantly from early detection when treatment delays increase the risk of death. Many Early Warning Systems (EWS) have thus been developed to stratify those at high risk of deterioration. It has been demonstrated that different types of EWS, including the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and NEWS2, are clinically useful when identifying rapid deterioration. However, as we are inundated with risk stratification tools, it can be hard to decide which we should or should not use.
Guest Editorial – Risk Stratification in Acute Medicine Read More
This article describes my personal journey through Acute Medicine from the late 1980’s and incorporates the development of Acute Medical Units (AMU’s), co-establishing the Society for Acute Medicine (SAM), as well as involvement in the development of training curricula, research and audit. I am deeply indebted to a great number of professional colleagues over the last three decades, who have been pivotal to the development of the Acute Medicine specialism, and many of whom in turn became presidents of SAM.
Guest Editorial – A personal journey in Acute Medicine Read More
For those of you who are not aware of what GIRFT (Getting It Right First Time) is, let me start by saying it is a brilliant idea, genius perhaps. The vision of its founder, Professor Tim Briggs CBE, was to optimise orthopaedic care by using the most clinically and cost effective treatments, minimising waste, reducing variation and eliminating poor practice. Since 2014 in orthopaedics alone, operational and financial opportunities to save the NHS £696 million have been generated. Acute medicine, coupled with general medicine, has been part of the GIRFT programme since 2017. The mischievous reader might question the name, as clearly this is about getting things right at the second time of asking at the very earliest. Apart from that pedantic note, GIRFT is a force for good.
Acute Medicine and Pandemics: Getting It Right Next Time! Read More