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.
National Institute of Clinical Excellence
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.
Working Group
The Royal College of Physicians has formed a working group evaluate current service provision in hospital for acute medical care. The work includes:
- a survey of current service provision
- an audit against the guidelines and recommendations in the recent reports
- a correlation between Hospital Episode Statistics and clinical outcomes.
References
Page last updated by J Messias 25 March 2010