The nature of Acute Medicine requires physicians to make ‘high stakes’ decisions on a regular basis. The constant pressure to create space within a busy Acute Medical Unit needs to be weighed up against the dangers of missing serious pathology due to a premature discharge. A visit to the Coroner’s court or the fear of litigation may make us more cautious, but even the most cautious physician will ‘get it wrong’ on occasions. Case reports submitted to this journal frequently highlight these dangers; rare or serious pathology masquerading as a common or benign illness, followed by an unexpected deterioration, is a regular theme. Early Warning Scores have helped to improve safety for those patients who remain in hospital – Katherine Rowe’s article on p8 discusses the value of Critical Care Outreach in supporting this process. However neither of these innovations is of use for those patients discharged home. The ability to provide early AMU-based follow-up clinics is an important element in reducing risk for this group. The case report on p24 from the team at Hutt Valley Hospital in New Zealand illustrates the value of early reassessment following discharge. In this case the diagnosis of lead poisoning was not considered as a cause for the patient’s myalgia at the time of admission – an understandable ‘miss’, given the apparent chest x-ray abnormality. However, early outpatient CT with follow-up enabled revisitation of the history and the correct diagnosis was made – with a favourable outcome. As finances become stretched over the coming months there will be pressure to reduce hospital follow-up visits. However any drive from Primary Care Trusts to reduce AMU follow-up clinics as a cost-saving measure needs to be resisted if we are to optimise the safety and efficiency of our service.
On a different note, I am grateful to those of you who completed the on-line journal survey which was circulated to Society for Acute Medicine members earlier this year. I will aim to include a summary of the results in the next edition. The free-text sections have generated a number of interesting ideas, which we will try to incorporate into future editions on the journal. Many respondents indicated that they would like to see inclusion of more original research; however we remain dependent on submissions we receive, which explains the predominance of case reports in this, and previous, editions. The content of the journal can only be as good as the material we receive, so please keep the submissions coming, particularly AMU-based research projects and completed audits. I am also keen to expand the pool of expert referees for future articles. If any readers would like to contribute to this process, I would be grateful if you could contact me directly at the email address shown on this page, indicating your particular area of interest or expertise.