The quality of care in AMU has a significant and disproportionate impact on hospital outcomes. Early expert involvement reduces mortality and reduces the risk of hospital associated harm by shortening length of stay.1,2 Sensitive communication during the frightening initial phase of hospital admission can enhance patient and family experience and reduce anxiety.3,4 The inception and development of Acute Medicine as a specialty has done a great deal to improve the early hours of hospital care, but there is still room for improvement. The professionals who work in AMUs are good at delivering excellent care to the patient in front of them, but an extra step is needed to ensure reliable performance, with every patient getting every item of care that they need, whatever the time, day or night. It can be frustrating and difficult to make the changes needed to achieve this and it requires skills that do not ‘come as standard’ in the current medical or nursing curriculum. [download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]