Acute medicine


Acute medicine has developed over the last decade in response to the increasing number of medical admissions, concerns over quality of acute care(1,2) and other pressures including the European Working Time Directive [EWTD].

 

Improving and understanding quality of care is essential, however it is recognised for example that outcomes for patients admitted as an emergency, including issues related to patient safety, differ between hospitals (3) Although some of this variation may relate to case mix and social deprivation, much remains unanswered. (3)  For example, there is evidence that mortality is greater for patients who are admitted at weekends and this appears unrelated to illness severity (4, 5).

 

Defined training programmes are now in place for Acute Medicine (6) and trainees are now being appointed to consultant posts. However the systems which operate in hospitals vary and there has been little evaluation of the systems in place and in particular how these relate to patient outcomes. Recent publications supports improved outcomes with more structured systems of care (7,8,9) but as yet these have not been validated by similar publications.

 

Previously, the Royal College has surveyed the numbers of posts in Acute Medicine and some elements of the systems in place but has not related this to patient outcomes. Several factors can influence the quality of care and hence clinical outcome. Two key areas have been recognised for centuries (Hippocrates) – competence and process of care.

 

The National Institute of Clinical Excellence [NICE], the Royal College of Physicians and the National Enquiry into Patient Outcomes and Deaths (NCEPOD) have all recently produced reports related to the management of acute medical emergencies10,11,12. In addition, with the new consultant contract in place and acute medicine developing rapidly as a specialty it is an appropriate time to evaluate the role of the consultant in acute unselected take. This would be seen as the first phase of a longer term project to evaluate the role of the structure and organisation of acute medical care.

 

The Royal College of Physicians has formed a working group evaluate current service provision in hospital for acute medical care. The work includes:
i. a survey of current service provision,
ii. an audit against the guidelines and recommendations in the recent reports,
iii. a correlation between Hospital Episode Statistics and clinical outcomes.

 

Downlaod the Full Report (opens in new window - pdf)

 

The initial work has been funded by the Royal College of Physicians and is a pilot study to test the feasibility of the project.

 

For further information, please contact:

leyla.ozkan@rcplondon.ac.uk

 

 

  References 
1.

Seward E et al A confidential study of deaths after emergency medical admission: issues relating to quality of care. Clin Med 2003;:425

 2. Cullinane M, Findlay G, Hargraves C, Lucas S.  An acute problem?  National Confidential Enquiry into Patient Outcome and Death 2005
 3. Jarman B et al Explaining differences in English hospital death rates using routinely collected data. BMJ 1999;318:1515
 4. Bell CM, Redelmeier DA.  Mortality among patients admitted to hospitals on weekends as compared with weekdays.  N. Engl J Med 2001; 345: 663-8
 5. Cram P, Hillis SL, Barnett J, Rosenthal GE, Effects of weekend admission and hospital teaching status on in-hospital mortality.  AM. J. Med 2004: 117: 151-157
 6.   Acute medicine curriculum JCHMT
 7. Moore S, Gemmell I, Almond S et al.  Impact of specialist care on clinical outcomes for medical emergencies.  Clin. Med 2006; 6:286-93
 8. Schmulewitz L, Proundfoot A; Bell D.  The impact of weekends on outcome for emergency patients.  Clin. Med.2005;5: 621-625,
 9. Paterson R, MacLeod DC, Thetford D, Beattie A, Graham C,  Lam S and  Bell D.  Prediction of in-hospital mortality and length of stay using an early warning scoring system: clinical audit.  Clinical Medicine. 2006; 6: 281-284
10. NICE Short Clinical Guideline Technical Team (2006) Acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital. London: national Institute for Health and Clinical Excellence.
 11. Acute Medicine Taskforce. Acute medical care. The right person, in the right setting – first time. Report of the Acute Medicine Task Force. October 2007. Royal College of Physicians (London).
 12. NCEPOD: “Emergency Admissions: A journey in the right direction? A report of the National Confidential Enquiry into Patient Outcomes and Deaths” (NCEPOD) October 2007.

 

Page last updated by LO 27/01/2009