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New toolkit to support high quality care for acutely ill patients

The pressures on acute medical services in NHS trusts are immense. Increasing numbers of patients with medical emergencies are being admitted to hospital, particularly elderly patients with multiple, complex medical conditions. This workload requires care to be organised on the basis of 7 day working and to  ensure that sufficient staff with the right skills and expertise are available to not only meet demand, but also provide the best outcomes for patients.

A new toolkit launched today by the Royal College of Physicians (RCP) highlights the key principles of high quality care applicable to all patients and makes recommendations in relation to six recognised problem areas:

  • Limited acute consultant physician hours in AMU (acute medical unit) – recommendations cover job plans, rotas, the mix of consultants involved, clinical leadership and teaching
  • Standardisation of early warning scores to track deteriorating patients and trigger intervention – recommendations include the implementation of the forthcoming National Early Warning Score (NEWS) to identify patients whose condition is deteriorating and take early corrective action
  • Standardisation of documentation and prescribing - particular reference is made to medical record-keeping across the NHS using standards developed by the RCP’s Health Informatics Unit, and developing and using standardised observation, prescription and fluid balance charts
  • Procedures for transfer of patients out of AMU – clinical handover - the importance of high quality handover is emphasised in line with the detailed recommendations made in the previous Acute Care Toolkit 1: Handover, published in May 2011
  • Patients transferred out of AMU: continuity of care and early consultant review – recommendations include ensuring that transfer decisions are based on patient need, enhanced (daily) consultant review on receiving wards, and establishing early, clear, consultant lines of responsibility
  • Discharge and maintaining flow through the medical admission pathway – recommendations centre on arrangements for consultant review and discharge of patients 7 days a week throughout the hospital, prioritisation of social services assessment,  and co-ordination of the discharge process to ensure this is prompt  and successful

Acute care toolkit 2: High quality acute care is the second RCP acute care toolkit, providing practical solutions and recommendations with the aim of improving the care of acutely ill patients. Acute care toolkit 1: Handover was published in May 2011.

Dr Mark Temple, RCP acute care fellow, said:

The relentless increase in emergency admissions is the number  one concern of doctors in the NHS. This pressure is likely to intensify in the next few years and the challenge to all staff is to ensure patient care is consistently safe and of the highest quality.


For further information, please contact Linda Cuthbertson, head of PR, on +44 (0)203 075 1254 / 0774 877 7919, or email Linda.Cuthbertson@rcplondon.ac.uk