This time last year, I was contemplating the predictions of Nostradamus, the possibility of a ‘barbeque summer’, and the hope that an Olympic ‘feel good factor’ would find its way onto the AMU. Longterm predictions are as tough for clinicians as they are for weathermen and 14th century apothecaries, but even looking a few days into the future can be difficult. In some ways it is the unpredictability of acute medicine which provides our biggest challenges: risk scores, early warning scores, and discharge prediction tools attempt to add some science to the subjectivity of clinical assessment. Every scientific meeting seems to feature a new biomarker, promising to eliminate uncertainty and improve accuracy, but probably opening a few cans of worms in the process. None of us has a crystal ball; recognising uncertainty – and communicating this to our patients – is a key skill which we all need to develop.
The challenge of delivering a high quality acute medicine service, 7 days a week, has been a major theme for 2012. Many readers will already have read the ‘Toolkit’ for delivery of a 7 day consultant service on the AMU, produced by the Royal College of Physicians (RCP) in association with SAM. This can be downloaded from the SAM website (www.acutemedicine.org.uk) along with the AMU Quality Standards which were released earlier in the summer. The article by Hannah Skene and David Ward on p205 complements these two documents, highlighting some of the practicalities in implementing quality standards across the 7 day week. This paper also comments on best ward round practice, a topic which has been the subject of some combined work by the RCP and Royal College of Nursing this year, and which provided the subject of the ‘best poster’, awarded to John Soon at this year’s SAM Autumn conference. The abstract from this presentation is included in the ‘selected abstracts’ article on p217.
During the summer I had the privilege to represent SAM at a reception organised by SepsisUK to co-incide with World Sepsis Day. The event featured some powerful, and moving talks from patients and relatives affected by sepsis, portraying the importance of early diagnosis and treatment for this devastating condition. Case reports in this journal over the past 10 years have demonstrated how often acute physicians are faced with atypical presentations of infection; this is particularly true for older patients as demonstrated in the cases on p 226. Ron Daniels’ ‘viewpoint’ article emphasises the important role which acute physicians have in recognising the signs of sepsis, ensuring early treatment and escalation to higher dependency areas where necessary. For patients who do not fall into any other clear cut speciality category during the first 48 hours of their hospital stay, acute physicians must provide the leadership and continuity of care which are essential in ensuring a good outcome.
January is a busy time on the AMU, so wishing you all a ‘Happy New Year’ may seem inappropriate to some readers. As I mentioned at the top of this editorial, my track record in prediction has not been good lately; however I hope it’s a fairly safe bet to suggest that – no matter how hard these next few weeks may get – the months which follow will probably be a whole lot easier!