Volume 16, Issue 1, Pages 1 – 48 (2017)

Resilience is a quality that acute physicians require in abundance. The ability to ‘bounce back’ from hardships, along with the attributes of ‘faith, hope, optimism and a sense of purpose’, described in the introduction to the article on p10, are particularly important to those working at the hospital’s front door during the early weeks of January. This year was no exception, with downstream pressures resulting from social care cuts adding to the perennial problems of winter illness. Thankfully the arrival of this Spring edition means that these weeks are behind us; the risk of tripping over a TV news cameraman in the emergency department corridor has fallen dramatically, and hospital communications teams can park the term ‘unprecedented demand’ for another year. The challenges, of course, continue, but ‘normal service pressure’ has now resumed – for a few months, at least.

The article by Elen Bradley-Roberts and Chris Subbe from Bangor provides an interesting perspective on resilience and its influence on patients with acute illness. Their literature review identified that this was an under-researched area in relation to acute medicine, with much of the data relating to patients admitted to critical care units. However, there are clearly parallels with the AMU, and a better understanding of the impact of an acute hospital admission on patients may help us to provide appropriate support following their discharge. This links with Rachel Kidney’s article on readmissions, which are frequently used as an indicator of the quality of hospital care provided to patients. After analysing a large database from St James’ Hospital in Dublin, the authors conclude that the factors most strongly associated with 30 day readmission are unlikely to be influenced by the care received during the hospital stay. The lack of variation from year to year, despite major changes in health services funding in Ireland over this period adds weight to their contention that 30 day readmissions are likely to be unhelpful as a quality indicator. The Society for Acute Medicine currently recommends use of 7 day readmission figures as a more appropriate marker of AMU quality – aiming to reassure us that the pressure to shorten length of stay does not result in early readmission to hospital. However, the data from this paper may enable us to target interventions to reduce 30 day readmission amongst those patients at the highest risk. Many hospitals have already established community COPD services, which have been used to provide early supported discharge following admission with an exacerbation. Emergency Departments commonly have well developed links with community alcohol teams, although such services are often stretched too thinly. It may be that a combination of physical and psychological support, targeted at the groups of patients at highest risk of readmission to hospital, would be a costeffective model to reduce pressure on our services.

Enjoy what is left of Spring and early summer, and hopefully I will catch up with some of you at the SAM meeting in Cardiff in early May.