Acute medicine training has come a long way in a relatively short period of time. Acute Medicine was recognised as a speciality by the Royal College of Physicians in 2003, initially as a subspeciality of General Internal Medicine. Acute Medicine was formally recognised as a speciality in its own right in 2009.
The current state of Acute Medicine training Read More
My first piece of advice for all aspiring medical leaders would be this, ‘don’t bother’ with a leadership course, as nothing can fully prepare you for the role. That said, please continue reading as I will try and provide an honest review of my time as President to the Society for Acute Medicine (SAM).
Being SAM President – A Long Journey in a Short Time Read More
Conducting research on the Acute Medical Unit (AMU) poses unique challenges; the environment is one that sees a diverse range of patient groups and pathologies and holds the potential for easy patient recruitment to research studies, however is geared towards a specific set of triage and discharge goals. We conducted a study into Stress Hyperglycaemia (SH) on a busy AMU, which involved profiling glycaemic changes using specialist equipment and interventions in patients with unscheduled medical admissions, and experienced a number of challenges. This article discusses these challenges and proposes potential solutions. Conducting research on a busy AMU was complicated by factors including rapid patient and staff turnover, the differing goals of the AMU system and suboptimal staff engagement in labour intensive research. We endeavored to follow patients up in further visits after discharge but found they lacked engagement after the resolution of the acute illness requiring initial admission. In this article, we discuss these issues in more detail and suggest approaches for future AMU researchers.
The Challenges of Conducting Research on the Acute Medical Unit Read More
It had become a familiar routine. My seventh admission with diabetic ketoacidosis (DKA) in a year. Each time I was admitted it was the same; a DKA protocol, a diabetes specialist nurse visit, and a few questions from the doctors checking if “everything is okay?” On each admission, I would be discharged home after a couple of days. We all knew I’d be back again within a month or two.
Introduction
It’s a Monday morning; the week-end has seen the re-admission of a retired teacher with a dry cough, increasing dyspnoea and no physical signs. His chest X-ray ten days previously didn’t show any abnormalities. The course of amoxicillin given by his GP has not helped. He has an oxygen saturation of 89% at rest. Something doesn’t add up?
Which is more painful: an unsolicited PPI telephone call during clinic? Your hospital email on returning from two weeks annual leave? The strong realisation on waking at 3am that you have contracted norovirus like the rest of the team? Or a 10 minute powerpoint presentation? It’s the powerpoint. That is the most painful. And, painful as it might be and unlike the others, it is all your fault.
Abstract
The Acute GP Service has operated in Plymouth for the last 7 years. We have a mandate to improve patient care through supporting community GPs and their patients at the point of need for urgent medical assessment. I outline our service design and delivery and make the argument for the use of primary care physicians to help manage the interface between primary and secondary care.
Acute General Practice – the 7 year itch Read More
Abstract
Ambulatory Emergency Care is a key component of the service for many Acute Medical units across the United Kingdom. A well-functioning ambulatory care unit facilitiates early senior review by a consultant and may reduce the need for hospital admission by managing patients along alternative safe clinical pathways. In this article, we present 12 months of data (January 2014-January 2015) from our Ambulatory Unit at Wrightington, Wigan and Leigh NHS Foundation Trust (WWL NHSFT), which demonstrates how many different conditions can be safely managed along ambulatory care pathways and how this can significantly contribute to postive patient satisfaction survey results and meeting the A&E 4 hour target for a medium-sized Acute Trust such as WWL NHSFT. We also emphasise that the key factors of co-location of ambulatory care with the Emergency Department along with dedicated medical and nursing staff are essential to the success of this model of care.
Can Ambulatory Emergency Care have a positive impact on acute services? Read More
Abstract
This edition’s paper on ‘How doctors spend their time on an AMU’ defines ‘training’ as time spent on senior ward rounds. But the idea that senior ward rounds are training and the rest of work is not is a huge assumption that must be challenged. This article explores some false ideas about postgraduate medical education; why teaching and learning activities needs to be made more explicit, and why we need to stop talking about ‘training’ and start talking about learning. The goal of professional education is expertise, not competence. That can only happen through work-based learning, something to which we need to pay much more attention.
Viewpoint: What is ‘Training’? Read More
Introduction
Sepsis- the life-threatening response of the body to an infection- is one of the more common reasons for presentation to an Acute Medical Unit, and a major health and economic burden to our healthcare system, with an estimated 37,000 deaths occurring annually in the U.K. In the United States, recent evidence suggests that the incidence of sepsis has been rising by between 8 and 13% per annum over the last decade, and that it is now higher than that of Acute Coronary Syndrome.1 Across Europe, the cost of a hospital admission for sepsis (due to the frequent need for prolonged Critical Care admission) has been estimated at between 25,000 and 55,000 Euros.2 For the NHS, this means an estimated expenditure of £2.5 billion per year.
Sepsis- what is the role for acute medicine? Read More