AMU

Examining trainee awareness of dermatoses and dermatological assessments during acute admissions (A quality improvement project)

Original Articles, Volume 17, Issue 3, Pages 117 – 172 (2018)

Abstract

Studies demonstrate 67% of elderly patients can have dermatoses, which could result in functional and psychological consequences. Elderly presentations are further complicated by comorbidities and polypharmacy. This combined with limited dermatology training at undergraduate and postgraduate levels creates diagnostic challenges. This project investigated dermatology assessments by trainees using the Trust’s acute medical admissions proforma. 100 proforma were reviewed for skin assessments alongside nursing skin care bundles. Subsequently, a skin survey was conducted amongst trainees evaluating knowledge and confidence when diagnosing and managing common dermatoses. Successively, a dermatology teaching series was delivered. Post-intervention the above were reassessed, demonstrating  improvements in most areas. The dermatology teaching series will continue alongside a Trust hospital guideline to sustain improvements in dermatological care on admission.

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PRISMA Analysis of 30 Day Readmissions to a Tertiary Cancer Hospital

Research Audit and Clinical Practice, Volume 14, Issue 2, Pages 41 - 96 (2015)

Abstract

Background: Hospital readmissions are increasingly used as a quality indicator. Patients with cancer have an increased risk of readmission.
The purpose of this study was to develop an in depth understanding of the causes of readmissions in patients undergoing cancer treatment using PRISMA methodology and was subsequently used to identify any potentially preventable causes of readmission in this cohort.

Methods: 50 consecutive 30 day readmissions from the 1st November 2014 to the medical admissions unit (MAU) at a specialist tertiary cancer hospital in the Northwest of England were analysed retrospectively.

Results: 25(50%) of the patients were male with a median age of 59 years (range 19-81). PRISMA analysis showed that active (human) factors contributed to the readmission of 4 (8%) of the readmissions, which may have been potentially preventable. All of the readmissions were driven by a medical condition related to the patient’s underlying cancer and ongoing cancer treatment.

Conclusion: The majority of readmissions of patients undergoing cancer treatment appear to be related to the underlying condition and, as such, are predictable but not preventable. This suggests that hospital readmission is not a good quality indicator in this cohort of patients.

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Shared Experiences of Consultant Delivered Care – A toolkit for those responsible for configuring consultant delivered care in Acute Medicine

Research Audit and Clinical Practice, Volume 11, Issue 4, Pages 193 - 264 (2012)

Abstract

Background: NHS London released commissioning standards for Adult emergency services in September 2011. The Pan-London Acute Medicine Network (PLAN) agreed to survey its members regarding these standards.

Method: A web-based survey asked PLAN members to comment on the standards which were most relevant to Consultant-delivered care in Acute Medicine. The self-reported rate of compliance with each standard was calculated. The free text comments were grouped by thematic analysis.

Results: 23 responses were received. The compliance with each standard was variable between 9% and 91%.

Discussion: A series of themes are discussed and presented as tips to be considered by those responsible for providing Consultant-delivered care to patients on an AMU.

Conclusion: There is still enormous variation between trusts in how acute medical services are supported by Consultant physicians. The demands on each service and the resources available to trusts differ hugely, therefore the solutions to providing a Consultant-led service need to be tailor made for each AMU.

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Is there a role for a diabetes specialist on the AMU?

Viewpoint, Volume 12, Issue 1, Pages 1 - 64 (2013)

Many specialists have taken time to adjust to the development of acute medicine and Acute Medical Units (AMUs). As these concepts have evolved, so has the understanding of how specialists can better interact with their new acute medicine colleagues and how they help to ensure the smooth running of one of the most vital cogs of the hospital ‘machine’. For some specialties (Cardiology , Respiratory Medicine etc), it has been relatively straightforward to integrate into the new model - perhaps due to the sheer numbers of acute patients relevant to those specialties. However, for the chronic disease specialties such as diabetes, it has been less easy to understand how to optimize the interface with acute medicine.

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