Volume 8, Issue 3, Pages 95 – 138 (2009)

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.

Please subscribe to see more.
Subscribe
Already a member? Log in here

The Acute Physicians Unit in Scarborough Hospital Read More

An Unusual cause of ‘Troponinaemia’ – Answers

Picture Quiz, Volume 8, Issue 3, Pages 95 - 138 (2009)

The patient was initially commenced on intravenous antibiotics, aspirin, clopidogrel and low molecular weight heparin (LMWH) for a putative diagnosis of community acquired pneumonia complicated by acute coronary syndrome. However, following review of the chest x-ray and careful evaluation of the history, the diagnosis of Wegener’s Granulomatosis (WG) was considered and immunological tests were requested (table 1). Prednisolone 60mg daily was commenced pending the urgent Anti Neutrophil Cytoplasmic Antibody (ANCA) result. A palpable purpuric rash then developed over the dorsal aspects of both feet.

Please subscribe to see more.
Subscribe
Already a member? Log in here

An Unusual cause of ‘Troponinaemia’ – Answers Read More

An Unusual cause of ‘Troponinaemia’

Picture Quiz, Volume 8, Issue 3, Pages 95 - 138 (2009)

58 year old policeman presented with a 4 week history of cough, haemoptysis, exertional dyspnoea, ear discomfort and sore throat. He was previously healthy and taking no regular medications. He was a non-smoker and had no risk factors for coronary artery disease. He had recently completed two courses of antibiotics for a presumed ear infection. He had also experienced occasional minor epistaxis with constitutional symptoms of weight loss and night sweats over recent months. Clinical examination was unremarkable.

Please subscribe to see more.
Subscribe
Already a member? Log in here

An Unusual cause of ‘Troponinaemia’ Read More

Out-patient detection of deep vein thrombosis using a combination of risk scoring and strain-gauge-plethysmography: a follow-up study

Original Articles, Volume 8, Issue 3, Pages 95 - 138 (2009)

Abstract

Patients are frequently referred to hospital for exclusion of deep vein thrombosis (DVT); however, the diagnosis is only confirmed in 12% of those undergoing investigation. An effective strategy is required, which minimises the number of negative investigations, while safely excluding or confirming the diagnosis. This study investigates the combination of clinical risk scoring and strain-gauge plethysmography in the initial assessment of patients with suspected DVT. A survey was conducted of 1300 patients referred with suspected DVT over the course of a year. The results of this investigation were comparable to previous clinical trials and supports the use of strain-gauge plethysmography combined with clinical risk score in a busy acute medical unit.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Out-patient detection of deep vein thrombosis using a combination of risk scoring and strain-gauge-plethysmography: a follow-up study Read More

The Payment by Results (PbR) national tariff severely penalises efficiency and early hospital discharge

Original Articles, Volume 8, Issue 3, Pages 95 - 138 (2009)

Abstract

The system of Payment by Results (PbR) was instituted in 2005 to reimburse secondary care for its activity. One of the features of PbR is the short stay tariff (SST), in which only 20-50% of the national tariff is paid if patients have a length of stay (LoS) of less than 2 days in hospital for certain Healthcare Resource Groups (HRGs) – or conditions. We analysed the admissions under Acute Medicine at Bradford Teaching Hospitals over a period of one year and identified the HRGs to which the SST applied. We used the 2007 PbR national tariff to calculate the additional income that would have been generated if these patients were kept in hospital for at least 2 days in order to avoid SST. We calculated an extra theoretical income of approximately £5 million if all these patients had a length of stay (LoS) more than 2 days to avoid the SST. Sixteen additional beds (assuming 85% occupancy) would have been required at a cost of around £1million per year to accommodate these patients. We show that the current PbR system is flawed and penalises hospitals with a higher turnover of patients.

Please subscribe to see more.
Subscribe
Already a member? Log in here

The Payment by Results (PbR) national tariff severely penalises efficiency and early hospital discharge Read More

Do Patients Really Mind Mixed Sex Bays in an Emergency Assessment Unit?

Original Articles, Volume 8, Issue 3, Pages 95 - 138 (2009)

Abstract

Mixed sex bays are a reality on most Emergency Assessment Units (EAU). However, they are controversial having recently been the focus of political and media attention.

We adapted a validated patient satisfaction questionnaire to seek the views of 1000 emergency admissions regarding mixed sex accommodation.

Of 1000 respondents, 925 (92%) had been in bays and 665 (66%) shared with the opposite sex. Most 579/665 (87%) were comfortable with this, 97% (966/1000) feeling there was sufficient level of privacy, all (1000/1000) felt they were given privacy when needed. When asked ‘‘given the nature and function of EAU would you be willing to share with the opposite sex if it meant a shorter stay?’’, 857 (86%) said yes.

Our study demonstrates that whilst single sex accommodation is ideal it is not the most important factor to most patients admitted to EAU

Please subscribe to see more.
Subscribe
Already a member? Log in here

Do Patients Really Mind Mixed Sex Bays in an Emergency Assessment Unit? Read More

Trimethoprim related Hyperkalaemia in a Trimethoprim related Hyperkalaemia in a

Case Reports, Volume 8, Issue 3, Pages 95 - 138 (2009)

Abstract

Hyperkalaemia is a common, treatable, medical emergency, often with an iatrogenic cause. This case illustrates the vulnerability of patients with pre-existing renal tubular acidosis type 4 to medications that further inhibit renin-aldosterone action. The case also illustrates the danger of keeping entirely separate case notes between different hospital disciplines.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Trimethoprim related Hyperkalaemia in a Trimethoprim related Hyperkalaemia in a Read More

“CURB” your enthusiasm and consider HIV

Case Reports, Volume 8, Issue 3, Pages 95 - 138 (2009)

Abstract

We present the case of a 40-year old female who was initially seen by her GP and the Emergency Department with pneumonia failing to respond to oral antibiotics. Her severity assessment score categorised her as being in a low risk group and she was discharged. Subsequent admission and further investigations diagnosed Human Immunodeficiency Virus infection and Pneumocystis jeruvici pneumonia. It is important for emergency departments and acute physicians to apply risk validation tools appropriately and to be alert to underlying immunosuppression.

Please subscribe to see more.
Subscribe
Already a member? Log in here

“CURB” your enthusiasm and consider HIV Read More

Current Approaches to Cardiopulmonary Resuscitation

Clinical Reviews, Volume 8, Issue 3, Pages 95 - 138 (2009)

Cardiac arrest occurs when there is abrupt cessation of effective pumping activity of the heart. Among the likely causes are ventricular asystole (electrical or mechanical), pulseless ventricular tachycardia or ventricular fibrillation. Clinically this may present as ‘sudden cardiac death’.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Current Approaches to Cardiopulmonary Resuscitation Read More

Shopping Basket
Scroll to Top

Start typing and press enter to search

Start typing and press enter to search