All Journals from Derek Bell
Acute medicine was recognised as a subspeciality of General (Internal) Medicine by the Specialist Training Authority in July 2003. In practice it had been growing as a clinical entity for over a decade and several reports have been published.1, 2, 3 The most recent Royal College of Physicians report on Acute medicine: making it work for patients4 states “Acute medicine in the UK requires the development of an academic and research base in order to support teaching and training at medical undergraduate and postgraduate level, to support basic and clinical research, to develop clinical standards, and to provide audit tools for the assessment of clinical performance.”
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Abstract
Overnight medical cover in hospital is less than during daylight hours. We aimed to quantify the numbers of patients deteriorating overnight and their clinical outcome. Data was collected in real time on use of the Standardised Early Warning Score (SEWS), ‘time to doctor’, seniority of medical review and clinical outcome.
136 incidents of clinical concern were noted on the general wards with a median response time of 5 minutes for SEWS>4 and 10 minutes if SEWS<4. 159 incidents were recorded in critical care. There was significant inter-speciality variation in median response times and seniority of responding staff, particularly within critical care, which recorded the slowest times across the hospital. This will be reassessed following the establishment of Hospital at Night.
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Abstract
Acute pulmonary embolism (PE) is a common presentation on the acute medical take. In our previous article in Vol 6 issue 1 we discussed the diagnostic approach to this condition. This article concentrates on the treatment of PE, including guidance for treatment of PE in pregnancy and cancer. This article also discusses the role of alternative anticoagulants, thrombolysis, surgery and inferior vena caval filters.
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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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During the late nineties it was not uncommon for patients to wait over 12 hours for admission to hospital and there were isolated reports of patients waiting between 24 and 48 hours on trolleys in accident and emergency and sometimes in corridors. My interest in this problem and the long delays experienced by patients in Emergency Departments in the UK developed during early work with the Modernisation Agency.
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