The end of the year is often a time for ref lection – many healthcare professionals have the opportunity of a couple of relaxing weeks over Christmas to draw breath and plan for the coming year with renewed enthusiasm. This is never quite true for Acute Medicine – any brief respite in the lead-up to Christmas week is soon forgotten during the chaos which follows. The ritual search for beds in any available hospital ward is as much a part of the AMU festive season as the Christmas party and the tinsel tree (circa 1980) – which will eventually be discovered, and banned, by Infection Control. However, it remains important to make time for ref lection and service planning. Syed Ahmed’s article on p114 demonstrates the value of this approach, with dramatic improvements in patient f low and achievement of emergency access targets following changes to their model of care. Of course the pressure to provide such improvements may be reduced, following the Health Secretary’s announcement of the intention to end the ‘4 hour target’ next year. Derek Bell’s ‘Viewpoint’ article on p137 provides readers with some of the history behind the original target, and expresses concerns regarding the dangers of a return to long, and inappropriate, waits on ED trolleys for medical admission. In order to avoid this, acute physicians will need to work with politicians to ensure that any new quality indicators include some measure of ‘timeliness’ in the assessment, initial management and movement of medical patients.
One of the effects of the 4 hour target has been a recognition that delays in obtaining blood test results can impact on the speed of decision making at the ‘front door’. This has often led to blood sampling being undertaken before clinical assessment has been completed. Ensuring that the appropriate results are available may lead to unnecessary testing, particularly tests of coagulation which cannot easily be ‘added on’ to existing samples at a later time. Lewis and colleagues remind us of the need to consider the costs of this approach – with a price tag in excess of £12 per coagulation sample it is likely that the pendulum will require a nudge in the opposite direction. Their educational programme was successful in reducing unnecessary coagulation testing, although sustaining this with new groups of junior doctors rotating through AMU on such as regular basis may prove to be a challenge.
The New Year will also be bringing changes to the structure of this journal. Starting from 2011, each volume will comprise four editions, printed ‘quarterly’ in March, June, September and December. The layout will evolve with fewer case reports and a move towards greater focus on research-based articles. The need for this change has been a regular subject of informal discussions with readers, as well as the reader survey which was circulated earlier this year and is summarised later in this edition. In the past this move has been inhibited by the lack of submissions, with case reports still comprising the majority of our weekly mailbox. However, the balance is gradually shifting, and this will also support our application for Indexing in MEDLINE which remains a vital part of this journal’s development. In response to comments from the large numbers of trainees who read the journal we are developing a new ‘Trainee Section’, and I am delighted to welcome Dr Tom Heaps, Acute Medicine SpR, onto the editorial board. It is planned to commission a cycle of ‘problem-orientated’ review articles, aiming to cover the entire knowledge-base of the GIM / AIM curricula during the next 5 years. This exciting project should complement the wealth of diagnosis-based guidelines already available, which are difficult to apply in the acute setting where the cause of a patient’s symptoms has yet to be determined. A regular ‘Journal Watch’ section, summarising recent articles of importance to Acute Physicians, and updates on developments in acute medical training will also feature in this section, which I hope will also be of interest to more senior physicians. Any readers who are interested in contributing to these sections are welcome to contact me at the email address shown on this page.