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Seven-day acute medicine service is improving patient outcomes Acute medicine is one of the youngest and fastest growing medical specialities which is playing an increasingly important role in improving patient outcomes. Hospitals began appointing specialists in acute medicine from the late 1990s to cope with a progressive increase in emergency medical admissions, a requirement to reduce junior doctors’ hours and to meet patient expectations for consultant-led care. It was also realised that a new breed of specialist acute medicine physician was needed to fill the gap left by hospital consultants becoming more specialised and spending less time on general medicine. The Society for Acute Medicine (SAM) was formed in 1999 to provide support for these new specialists and acute medicine has now been approved as a specialty in its own right. SAM was launched by a handful of consultants and now has a membership of over 450. The number of acute medical units (AMUs) across the UK has grown to 225. Specialist acute physicians are driving forward changes in the management of patients on the AMU, and several hundred specialist registrars are now training on the newly approved Curriculum in Acute Internal Medicine. A landmark document called Quality Standards for Acute Medical Units, was launched in June to help trusts achieve consistency in the quality and standards of care for patients admitted as an emergency. Dr Chris Roseveare, president of SAM and an acute medicine consultant at University Hospitals Southampton Foundation Trust, says: ‘We are providing a framework to ensure consistent standards of care in AMUs across the UK. This will enable AMUs to benchmark against other units and will reassure patients that the quality of care they are getting in their local hospital is as high as in any other part of the country.’
The standards emphasise the key role of specialists. The document stipulates that a consultant should be present on the AMU for at least 12 hours a day 7 days a week. Many units meet or exceed this but others struggle to achieve that target because they don’t have adequate numbers of consultants to provide that level of care. Dr Roseveare says that providing a 7-day consultant-led service is likely to improve outcomes for patients. ‘SAM is committed to promoting a consistent level of consultant care, 7 days a week; this will require reorganisation of services and more consultants. However the increased costs may be offset by better outcomes and shorter hospital stays resulting from earlier consultant involvement in a patient’s care’ The standards stipulate that a patient should be seen by a competent clinician within four hours and by a consultant within 14 hours of arrival at the unit. Many hospitals are already achieving that figure. Preliminary data suggest that over 80% of patients are being seen in that time and in some hospitals the figure is as high as 95%. ‘We are moving in the right direction, which is very encouraging,’ says Dr Roseveare. ‘The speciality has grown considerably since 1999 which is crucial for patient care. When patients first come in to hospital they are now more likely to see a consultant, more likely to get an appropriate diagnosis and more likely to get the right treatment.’ But Dr Roseveare says there is still a lot to do. The acute medicine workforce would need to expand considerably to achieve a 12-hour, 7-day consultant presence on AMUs across the country. At present consultants dually accredited in general internal medicine (GIM) and another speciality provide much of the weekend and out-of-hours care in many hospitals across the UK. This is crucial and will need to continue for the foreseeable future, even though the numbers of trained acute physicians is slowly rising.
Dr Chris Roseveare
The specialty also needs more junior doctors to specialise in acute medicine. SAM is currently working closely with the Royal College of Physicians to develop sustainable models of consultant working practice to encourage more doctors to consider the specialty as a career option. The nature of the shift pattern may also lend itself to ‘family friendly’ working arrangements for those who plan to work on a less than fulltime basis as a consultant. Dr Roseveare says the specialty needs to continue to develop at the rapid pace seen over the past decade. ‘In the future I believe that the acute medicine specialist should play a key role in the ongoing management of general medicine patients beyond the AMU. Acute medicine consultants, dually accredited with GIM, are ideally placed to provide this ongoing care for patients whose problem does not fall into the remit of any clear cut specialist category.’ Looking for an event focussing solely on acute medicine? SAM runs a dedicated annual event, for registration and further information please visit www.acutemedicine.org.uk Quality Standards for Acute Medical Units is at: http://www.acutemedicine.org.uk/images/stories/pdf/the%20 coordinator%20role%20in%20am.pdf
Toolkit set to raise the bar on the urgent care needs of older people There is a pressing need to improve the way we care for older people in an emergency Dr Simon Conroy will tell AGM 2012. This is because current services are too fragmented and poor communication between different clinical settings and professionals is affecting the quality of care older people receive, says Dr Conroy, a senior lecturer and geriatrician at the University of Leicester.
Dr Simon Conroy
In his talk Dr Conroy will be outlining how care can be improved using the Silver Book, a new toolkit which defines key standards for the emergency care of older people.
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Launched in June by a multidisciplinary group of stakeholders, the Silver Book recommends ways in which emergency admissions of older people can be reduced and the experience of those admitted improved. It considers all the clinical contacts which a patient might have during an emergency and suggests minimum standards and responses for each service including: primary care, ambulance services; emergency departments; urgent care units, acute medical units and community hospitals. Continued on page 2
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02/08/2012 12:42