How to Do It

The Acute Physicians Unit in Scarborough Hospital

How to Do It, Volume 8, Issue 3, Pages 95 - 138 (2009)

Abstract

Aim: The aim of Acute Physicians Unit (APU) in Scarborough Hospital is consultant led delivery of acute medical care. It operates weekdays from 9am to 5pm, staffed by a consultant physician, a trained nurse and an auxiliary nurse. We reviewed the APU activity over 38 months.

Results: 7170 patients were referred to APU, mainly from GPs (59.6%) and A&E (26.5%). The most common type of referrals: cardiovascular 21%, neurological 16.9% and respiratory 15.1%. It prevented admission in 2217 cases (30.9%): 22.4% were sent home after assessment in APU and in 8.5% telephone advice was sufficient.

Conclusion: The APU has led to early consultant review in 53% of admissions, discharge of 31% of patients and is a useful source of consultation for GPs.Abstract

Aim: The aim of Acute Physicians Unit (APU) in Scarborough Hospital is consultant led delivery of acute medical care. It operates weekdays from 9am to 5pm, staffed by a consultant physician, a trained nurse and an auxiliary nurse. We reviewed the APU activity over 38 months.

Results: 7170 patients were referred to APU, mainly from GPs (59.6%) and A&E (26.5%). The most common type of referrals: cardiovascular 21%, neurological 16.9% and respiratory 15.1%. It prevented admission in 2217 cases (30.9%): 22.4% were sent home after assessment in APU and in 8.5% telephone advice was sufficient.

Conclusion: The APU has led to early consultant review in 53% of admissions, discharge of 31% of patients and is a useful source of consultation for GPs.Abstract

Aim: The aim of Acute Physicians Unit (APU) in Scarborough Hospital is consultant led delivery of acute medical care. It operates weekdays from 9am to 5pm, staffed by a consultant physician, a trained nurse and an auxiliary nurse. We reviewed the APU activity over 38 months.

Results: 7170 patients were referred to APU, mainly from GPs (59.6%) and A&E (26.5%). The most common type of referrals: cardiovascular 21%, neurological 16.9% and respiratory 15.1%. It prevented admission in 2217 cases (30.9%): 22.4% were sent home after assessment in APU and in 8.5% telephone advice was sufficient.

Conclusion: The APU has led to early consultant review in 53% of admissions, discharge of 31% of patients and is a useful source of consultation for GPs.Abstract

Aim: The aim of Acute Physicians Unit (APU) in Scarborough Hospital is consultant led delivery of acute medical care. It operates weekdays from 9am to 5pm, staffed by a consultant physician, a trained nurse and an auxiliary nurse. We reviewed the APU activity over 38 months.

Results: 7170 patients were referred to APU, mainly from GPs (59.6%) and A&E (26.5%). The most common type of referrals: cardiovascular 21%, neurological 16.9% and respiratory 15.1%. It prevented admission in 2217 cases (30.9%): 22.4% were sent home after assessment in APU and in 8.5% telephone advice was sufficient.

Conclusion: The APU has led to early consultant review in 53% of admissions, discharge of 31% of patients and is a useful source of consultation for GPs.

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Providing Better Care for Patients with Complex Needs in Acute Medicine

How to Do It, Volume 8, Issue 2, Pages 51 - 94 (2009)

Abstract

Patients with complex needs are commonly admitted on the acute medical take and comprise a significant proportion of the workload for an acute physician. An innovative multi-professional approach to the assessment of this group of patients has been developed in Edinburgh; this paper summarises the results of a 4 week review of data collected on patients assessed by the multiprofessional team on the Medical Assessment Unit at Edinburgh Royal Infirmary.

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The Evolving Role of the Acute Assessment Unit – from inpatient to outpatient care

How to Do It, Volume 4, Issue 1, Pages 1 - 44 (2005)

Abstract

Acute Assessment Units (AAUs) have been developed to meet the demand for emergency care. Traditionally, AAUs have been an admission route to secondary care but the role is now evolving to assessment. AAUs are complex and have many interactions both in hospitals and the community. The effective functioning of an AAU requires excellent clinical leadership, appropriate facilities, timely access to diagnostics and input from the multi-disciplinary team. Increasingly, AAUs will have to develop services which are not dependent on using hospital beds. A variety of emergency medical presentations can, with the appropriate resources, be delivered in an out-patient setting.

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The Dix-Hallpike and Modified Epley Manoeuvres in the diagnosis and management of Benign Paroxysmal Positional Vertigo (BPPV)

How to Do It, Volume 3, Issue 1, Pages 1 - 44 (2004)

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common balance disorders and one of the easiest to diagnose and treat. It is characterised by short lived episodes of vertigo and geotropic rotatory nystagmus, which occur a few seconds after rapid changes in head position. The vertigo usually lasts no more than a minute and the symptoms reduce in severity with repetitions of the evoking movement.

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A practical guide to the examination and interpretation of pupillary responses

How to Do It, Volume 2, Issue 1, Pages 1 - 36 (2003)

Abstract

Examination of the pupillary responses, being simple, reliable and highly reproducible can elicit one of the "hard" neurological signs. In this article we provide an overview of their assessment in the acute setting, along with some tips on low to get the best from your pen torch.

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Chest Drain Insertion Indications and Techniques

How to Do It, Volume 1, Issue 3, Pages 77 - 117 (2002)

The ability to insert a chest drain safely and painlessly is an important core skill for physicians. This article describes techniques for insertion of larger bore trochar and cannula type chest drains as well as the more recent Seldinger guide-wire type drains. The indications for chest drain insertion will also be reviewed.

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Direct ophthalmoscopy for the acute physicia – papilloedema and other abnormalities of the optic nerve head

How to Do It, Volume 1, Issue 2, Pages 33 - 76 (2002)

Abstract

Direct ophthalmoscopy is an essential part of the full systemic examination. However, the technique is challenging and time-consuming. In the acute medical setting therefore, it is advisable for the physician to identify the subgroup of patients in whom examination of the fundus is most likely to be helpful.

Ophthalmoscopy should be performed where papilloedema is suspected, in those with an altered level of consciousness or other focal neurology, those with an unknown systemic disorder, and those complaining of visual disturbance.

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