On 16th October 2011 a small team from University hospital of South Manchester (UHSM) took part in the Amsterdam Marathon
New to running, pharmacist Vicky Hoskins completed the 8K with relative ease. Staff nurse Emma Widowson accepted the challenge of her first marathon, breaking the magic 4-hour barrier. SAM Secretary Mark Holland came out of retirement from long distance running and sported a SAM t-shirt which displayed not only the logo but the dates of next year’s meetings and the SAM website address. Star performer was consultant acute physician Dr Olivier Gaillemin who sprinted around the city in 2 hours 56 minutes, placing him in the top 400 out of 10000 finishers.
The UHSM team are now planning to recruit AMU staff for a run in June 2012 to coincide with the Acute Medicine Awareness Day. The SAM logo will again be on display.
With the clinical quality indicators for acute medicine now finalised the Society would like members to participate in a survey which will determine whether units are in a position to collect the agreed data.
We are also looking for units who are prepared to take part in a pilot data collection scheme. We would like as many members as possible to take part in the survey which should only take 10 minutes, to do so please follow this link.
Acute News caught up with the Society’s new President, Dr Chris Roseveare, shortly after he took over the role at the SAM meeting in London to discuss his vision for the speciality over the next two years.
Chris has always been an extremely committed and active SAM member; he was Treasurer for nearly eight years and Vice President for two. ‘I have a real passion for the specialty’ Chris says, ‘and I hope that this will inspire others in a similar way.’
It was partly the political focus on emergency care and the four hour target that helped acute medicine grow so rapidly as a specialty but Chris admits it will be challenging continuing that growth as financial pressures begin to bite and the focus shifts away from time-based targets.
Of course, changes in the political landscape have little real effect on the everyday workings of the AMU. ‘The numbers of patients being admitted to our AMUs daily show no sign of abating,’ Chris notes, ‘and it will be down to us to ensure we continue to provide the safe, high quality, senior-led care which they deserve.’ And a key element in providing this care is the establishment of seven day working.
‘It is going to be a huge challenge, but one which we cannot ignore, with the growing evidence that patient outcomes are worse following weekend admission. SAM is focussing heavily on this area and will shortly be producing a position statement which outlines our recommendations on implementing seven day working in AMUs.’
Another important area Chris will be overseeing is the introduction of SAM’s quality indicators and standards into AMUs around the country.
Chris says: ‘My predecessor Dr Philip Dyer worked tirelessly to produce these and implementing them over the coming years will enable us to demonstrate that we are providing safe and consistent service across the country. Ultimately these may become the framework for a system of accreditation for AMUs, which the RCP is keen to support.’
Having been closely involved in organising SAM meetings over the years Chris is keen to ensure they remain as inspiring and enlightening as ever.
‘The meeting in Dublin next spring will be the 25th meeting which SAM has held, and we hope that this will be a very special event… It was great to see so many delegates join us from outside the UK at this year’s meeting, with a particularly large delegation from the Netherlands who are keen to further develop the speciality of acute medicine.’
The Society meetings have given those involved in acute medicine the chance to shape the specialty, and while that must continue Chris feels it is vital that we spread the message of acute medicine as far and wide as possible.
‘This process has already started,’ Chris explains, ‘SAM is now represented on the key committees at the Royal College of Physicians, and has been involved in the development of many NICE guidelines; increasingly we are being asked to contribute in key policy decisions, so our voices are being heard at the highest level. However the awareness and understanding of our speciality amongst the public and some areas of the medical profession remain variable. Over the next two years I would like this to change. We are planning an Acute Medicine Awareness Day next June and will be encouraging AMUs to participate in events designed to raise our profile, and improve understanding of who we are and what we do.’
There may be far more SAM can do for acute medicine but Chris believes it will be bringing in new blood that will ensure future growth.
‘We have come a long way in a short space of time. Now we need to look forward. There are many newly appointed consultants now arriving on the scene who have been trained specifically in acute medicine. These consultants are already making a great contribution to the speciality, bringing new ideas and developing new services. We need to these individuals to engage with SAM and help us to drive acute medicine into the next decade.’
Acute Medicine: Making it Safer, Doing it Better: the 5th International Conference of the Society for Acute Medicine, Imperial College, London, 29-30th September 2011
Six hundred acute medicine professionals descended on an unseasonally hot and humid London to attend the 5th international SAM conference. Delegates from around the UK were joined by a large number from further afield, including Australia, New Zealand and the USA. The European contingent included a particularly large group from the Netherlands where acute medicine is rapidly developing.
Delegates were welcomed to Imperial College by Professor Derek Bell, the inaugural President of the Society and a key local member of the conference organising committee. He opened the initial Plenary session, ‘The Political Landscape and Acute Medical Care’ with some reflections on the importance of ensuring that acute medicine adapts meet the challenges of the changing NHS. Alan Dobson from the Royal College of Nursing and Professor Sir Peter Rubin, President of the General Medical Council continued this theme; Professor Rubin summarised the timetable for revalidation, indicating the influence of the Bristol enquiry into Paediatric surgery in driving forward this change. During questions, delegates pressed him on the time required to undertake robust data collection and appraisal – he re-iterated the needs for hospital Trusts to ensure that time is allocated during job planning.
The session ended with the presentation of the Third SAM Honorary Fellowship to Major General George Cowan, who was instrumental in ensuring speciality recognition for Acyte Medicine. After receiving the award from outgoing SAM President, Phil Dyer, he summarised his ‘Experiences in Acute Medicine’ with a series of entertaining anecdotes collected during his working life in the British army.
This year featured a particularly strong parallel programme for nurses and Allied Healthcare Professionals which ran through both days of the conference. Chaired by Alan Dobson, the sessions reflected the overall theme of the conference of quality and safety, underlined by the title ‘Acute Medicine: Making it Safer, Doing it Better’. The conference organisers were pleased by the healthy multiprofessional attendance at the meeting, particularly given the difficulties which non-medical staff have had recently in obtaining funding to attend. However clearly more needs to be done to encourage an even larger attendance in future years, and SAM will be working with the nursing and AHP representatives on Council to identify ways in which we can help Units to raise funds for this.
One of the key highlights of the international SAM conferences is the opportunity to hear acclaimed International speakers. This year’s meeting did not disappoint in this respect. On day one, Professor Salvatore di Somma from Rome and Professor Frank Peacock from the USA described how biomarkers can be used in risk stratification; many delegates were able to identify with the challenges of improving safety in discharge, particularly when there is pressure to make decisions soon after the patient has arrived. In the same session Tobias Breidhardt from Basel in Switzerland described some key technological advances in the management of the cardiorenal syndrome which are the subject of his current research with the University of Nottingham. SAM was delighted also to welcome back Professor Victor Tapson, who had previously spoken at the 1st International meeting in 2007. On that occasion his subject was pulmonary embolism; this time he focussed on the recognition and early treatment of pulmonary arterial hypertension, a rare but important differential diagnosis to consider for the patient with unexplained breathlessness.
Once again one of the most popular and diverse sessions was the Oral Poster Presentations. ‘It’s always my favourite session,’ said Dr Philip Dyer, chairing the parallel session on the second morning of the conference. ‘The standard over the years has just gotten higher and higher and it is always exciting to see what our members are doing in their units to improve acute care’. Over 100 posters were selected for display from more then 250 abstract submissions, and a number of these were awarded ‘highly commended’ rosettes by a judging panel.
John Heyworth, past President of the College of Emergency Medicine, chaired the opening plenary session of day two entitled ‘Acute medicine and emergency medicine: the interface’. His opening remarks stressed the importance of ensuring that acute care remains at the top of the health care agenda. He described the ‘Axis of Access’ as being key to maintaining patient flow through AMUs and Emergency Departments, identifying the importance of close collaboration between these two specialities over coming years. ‘It’s time for those in positions of power and influence to recognise the importance of acute and emergency care’, he said, while emphasising the need to take action quickly to ensure that we have influence in clinical commissioning groups. Clinical challenges which may present either to emergency or acute physicians were the theme of the remainder of this session. The clinical theme continued with ‘New Perspectives on Old Problems’ – Professor Brian Gazzard challenged delegates to consider HIV testing for most – if not all – all acute admissions and former RCP President Sir Ian Gilmore presented the frightening rise in the incidence alcoholic hepatitis particularly among younger patients: clearly a problem that acute physicians will face increasingly in their practice over coming years.
In the final plenary session, ‘Acute Medicine: Better and Safer’, inspiring talks from both sides of the Atlantic provided delegates with food for thought as they conference drew to a close. Professor Bob Wachter, considered the ‘father’ of the Hospitalist movement in the USA, described the dramatic expansion of this speciality which now boasts 30,000 members. ‘Acute medicine is not as far advanced as it should be with regards to patient safety,’ he said, calling on acute physicians in the UK to follow the lead of Hospitalists in placing patient safety.
The meeting saw Phil Dyer pass the Presidential baton to Chris Roseveare, who now starts his two year term. Chris has been involved with SAM since the beginning and was one of the original five committee members in 1999; however in closing the conference he stressed the need now to look forward to greater involvement from the next generation of acute physicians. ‘Ten years from now the SAM council will look very different to how it looks today’. He said, ‘It is essential that the new breed of trained acute physicians steps up to the plate and carries the specialty through to the next decade and beyond’. Chris thanked delegates for attending and we look forward to seeing as many of you as possible at our 25th SAM conference in Dublin next Spring.
At least that’s what our President says and of course he is a man of both taste and integrity. Sadly he is also a man who will be leaving us at the end of the SAM London Conference. Acute News cornered Dr Philip Dyer to find out what he is most looking forward to at his last event at the helm.
‘I’m really looking forward to the update from the Acute Medicine Taskforce,’ Dr Dyer said, ‘and especially hearing from Nigel Edwards of the Kings’ Fund who will be talking about the implications of healthcare reform. It is vital that we have a clear picture of how we fit into the medical landscape so we can adapt and ensure our survival.
Like many delegates, Philip is especially looking forward to the session ‘Leading Edge Technology in Acute Care’. Professor Salvatore Di Somma and Professor W. Frank Peacock (from Italy and the US respectively) will be presenting on biomarkers and heart disease risk stratification.
‘The talk on biomarkers will be very good,’ Dr Dyer said, ‘and the one on risk stratification is so important, we really need to develop our understanding there and I think this talk will be incredibly beneficial.’
Other highlights include:
‘Acute Medicine and Emergency Medicine: The Interface’. Chaired by Dr Chris Roseveare and Dr John Heyworth (President, College of Emergency Medicine) this session will examine various conditions and cases from both the acute medicine and emergency medicine perspective.
‘Acute Medicine; Safer and Better’; the session which embodies this year’s theme features a much anticipated presentation from the internationally renowned patient safety expert Professor Bob Wachter.
Finally, don’t miss; ‘Topical issues for the multi-professional team’; quite literally something for everyone!
Of course these are just some of the highlights, please click here to see the full programme.
To register visit the meetings page of the Society website.
The 5th International SAM meeting is being held on 29th and 30th September 2011, at Imperial College in London. As usual, there is a packed programme with a diverse range of topics and speakers – hopefully something for everyone!
The trainee session is taking place at the end of the first day in the Reed Lecture Theatre. We have chosen a similar format to last autumn’s session; there will be three short talks from trainees about their specialist skills, followed by two longer presentations covering some important areas of professional development (from both a practical and a political point of view).
The full programme for the conference is available through the SAM website.
We have been aware for a while that there are disparities in specialist skill provision both between and within deaneries – and the SAC is working hard to identify problems in this area. More recently, the issue of funding for specialist skills has been raised. It seems that some deaneries are happy and able to contribute towards the cost of training in a particular skill, while others are not; in at least one deanery, part-funding has now been withdrawn, leaving trainees to cover the entire cost of their chosen skills training. As specialist skill training is now a mandatory part of the Acute Medicine curriculum, we need to find a way to eliminate disparity both between different deaneries and between different skills. However, there is no easy solution, and for the time being, trainees will have to factor in the potential financial implications of a particular skill when they are considering their options.
On a brighter note, the list of recognised specialist skills has increased over the past year. Palliative Care has been authorised as a suitable skill, and Medical Ethics and Law will soon also be added to the list. If you would like to propose a skill that is not currently listed in the Acute Medicine curriculum, you should discuss it with your training programme director, who can bring the proposal to the Acute Medicine Specialty Advisory Committee (SAC).
Acute Medicine SCE
Registration for this year’s specialty certificate examination is now open. If you would like to apply, please go to the MRCP(UK) website where you will be taken through the steps in the application process. This year’s exam is due to take place on 23rd November, and the registration period for UK candidates ends on 19th October.
We are hoping that a Masterclass in SCE preparation will be held at the next SAM conference, on 30th September. This will be a great opportunity to hear tips from the experts, and to share revision resources with your colleagues.
A lot of work has been going on behind the scenes to try and improve the functionality of the ePortfolio website. Many trainees will still be able to see multiple curricula when they log in to their ePortfolio – and this has been causing confusion because they do not know which curriculum they should rate themselves against or populate with linkages. Over the next few months, additional curricula will be removed, so each trainee should only be able to see the curriculum that they are actually following. This change will also help to make trainees “more visible” to their training programme directors, so that their educational progress can be followed more closely.
For those of you who are undertaking both General and Acute Internal Medicine training, there is still no way to “cross populate” between the two curricula. We would advise you to fill in the majority of your competencies and linkages on the Acute Medicine curriculum, adding links from here to the General Medicine curriculum where appropriate.
Over time, additional documents will be added to the ePortfolio. These will include specialty-specific DOPS forms, the Patient Survey tool, and templates to allow clinical supervisors from specialty attachment blocks to upload attachment reports directly onto the system. Simplification and standardisation is the key!
Length of ACCS training
There has been a lot of confusion recently about the length of ACCS training. While trainees on the Emergency Medicine and Anaesthetics streams of the programme have had their third years confirmed, some of those on the Acute Medicine stream have been told by their deaneries that their training will only be two years long, in keeping with Core Medical Training. Both SAM and the SAC support the three-year programme, but further discussions with the higher training boards are ongoing – and a final decision should be reached by September 2011.
At a recent SAM strategy meeting, we discussed the possibility of writing a library of information leaflets for patients and relatives attending the AMU. These leaflets would contain AMU-relevant information about diagnoses, treatment options and procedures, and could be made available on a national scale. This would be a great project for an enthusiastic group of trainees to take on. If you would like to get involved in this, or any other Acute Medicine-related projects, please do get in touch with us.
Amy Daniel email@example.com
Alice Miller firstname.lastname@example.org
SAM Trainee Representatives
The Society is researching the possibility of an acute medicine awareness day, or possibly, week, to be launched next year.
The event will aim to raise the profile of acute internal medicine with other healthcare professionals and departments as we believe our specialty must be clearly understood within primary and secondary care settings before we can raise awareness with the wider public.
The planning of this awareness event is still in the early stages and we are keen for members to actively participate during the event, and also, to contribute ideas as to how we can better inform our colleagues of our work.
If you have an idea, or want to offer your services in any way, please email email@example.com.
Recently the SAM Research and Audit Group launched a project that aims to collate the details of all AMUs in the UK to help develop a closer working relationship between the Society and its members.
As a small incentive to take part in the SAMURAI survey (please do submit your entry here) SAM offered members the opportunity to win two free places at our London meeting worth £800.
The lucky winners were Fenella Hill and Stuart Henderson from Salisbury NHS Foundation Trust, we look forward to seeing them both at SAM London.
Research carried out by the Society and the RCPE which discovered that 90 per cent of doctors believe patient safety is compromised during the August trainee changeover garnered a huge amount of media coverage last month.
The survey results also showed that the majority of respondents think the changeover negatively affects both patient care and doctors’ training.
‘The results of this survey add to the emerging evidence base which indicates that the current August changeover system increases a number of risks for patients, including an increased early death rate for patients admitted to hospital at this time,’ said Dr Louella Vaughan, Honorary Consultant Physician in Acute Medicine, and lead author of the study.
Respondents said the detrimental effects of the changeover lasted up to a month and that the system would be improved if the changeover was staggered according to grade and moved to a time of year that would not conflict with the holiday period.
Dr Neil Dewhurst, President of the Royal College of Physicians of Edinburgh, said that the situation has reached a point where it can no longer be ignored.
He said: ‘Other changes to established systems within healthcare have been shown to deliver real improvements for patients and similar consideration must be given to making the changeover in training safer. We would urge the Scottish and UK governments to review this matter as a matter of urgency.’
However, the Scottish Government at least does not agree there is a problem with the current system. In response to the survey a spokeswoman said there was ‘absolutely no evidence’ that the August changeover affected patient safety.
The results of the survey were reported in the Scotsman, the Daily Mail, the Daily Mirror, the Herald, the BBC (online and radio), STV, among others.
New fees: From the 1st October 2011 the membership fee will rise to £95 (full price) and £45 (reduced). On the same date a direct debit payment option will be introduced. Members are reminded that they need to cancel any standing orders as these are being phased out.
Online journal access: In the autumn members will be able to read the Acute Medicine Journal online, for more information please contact our Administrator Korina Leoncio at firstname.lastname@example.org.
Council elections: Voting has begun in this year’s council elections: SAM is looking for a Vice President, a Nursing Representative, a Trainee Representative and an AHP Representative. Every member has been sent a unique link to their own voting form where they will also find each candidate’s statement of support. If you cannot find your link please email email@example.com. Voting ends on the 16th September.
List of candidates:
Candidates for the Nursing Representative post:
- Helen Pickard
- Mark Oakley
- Pauline Rafferty
Candidates for the Trainee Representative post:
- Ninith Narayan
- Kirk Freeman
- Thofique Adamjee
Candidate for the Vice President post:
Candidate for the AHP post:
‘Discharge planning is the most important policy in the NHS and the best discharge planning is about reducing the length of stay, improving the quality of care, making that care patient, not process, centred and reducing readmissions.’
So says Liz Lees, and she should know, having just edited a massive 32 chapters on the subject, submitted by a huge range of healthcare professionals.
‘Those who buy the book will encounter a wealth of experience; they will get practical tips and can learn from other people’s mistakes and successes.’ She says.
This is Liz’s second book on discharging and is a far more practical guide than the first. ‘It is not academic textbook,’ Liz explains, ‘it will appeal to operational staff. It is a vehicle to showcase and share pockets of excellence around the UK’.
While Liz’s first book was aimed at nurses this is very much a multi-disciplinary text, there are chapters written by doctors and nurses and perspectives from a pharmacist, an occupational therapist, a social worker and from the PALs team.
‘There is so much great work being done out there,’ Liz says, ‘but people don’t generally write it up unless you give them a chance. And when you do it is absolutely inspirational.’
About 50 per cent of the book is dedicated to a range of case examples, real life stories that are told in the hope of advancing practical changes that will improve the patient experience. They range from a district nurse case focusing on the issues of communication and transfer problems to a case which features the safeguarding of older adults.
Liz says: ‘Each example is firmly grounded in a clinical practice offering, vignettes and practical tips as situation based learning. They illuminate the reality of practice issues but attempt deal with them in a constructive way.’
There is of course plenty in Timely Discharge for an acute professional, the four chapters written by Liz herself are all drawn from her experience on the AMU. However, Liz worked hard to ensure that areas of the hospital are represented.
Working hard is an integral part of Liz’s life; she planned, sourced and edited the book while employed on the AMU full-time, not to mention she is currently writing her PhD thesis. Plus her recent trip to Australia to talk about discharge planning. No doubt all she wants now is a rest, perhaps for a year, maybe two? No. She’s already planning her next book. It will be her third publication on discharge planning, and this time she’ll be taking it worldwide.
Council members gathered in July to review their previous efforts on behalf of SAM and to plan what their next endeavours should be.
Despite some technical difficulties with the video conferencing (the council was split between Edinburgh and Birmingham) determined discussion commenced at 10.30am. Dr Philip Dyer made the introductions and checked off the actions from the past strategy meeting noting that most had been completed successfully. Checked actions include the redesign of the website, the appointment of a communications executive, expanded social media presence, development of a new logo and a sponsor’s pack (A Guide to Acute Medicine).
Review of the Acute Medicine Quality Indicators
The council is keen to ensure SAM is key in developing these indicators, which will be used to audit all AMUs. Four basic measures were agreed at the meeting which will now be taken forward and discussed with the RCPL before being finalised with the Department of Health. The Society is pushing for clear and practical indicators that are will ensure high standards of care. They are also working on AMU standards which are – for now – aspirational, they will encompass what they hope an AMU can offer in the future.
SAM strategy; the future
Much of what the Council will be doing in the coming months will be answering questions thrown up at the strategy meeting.
What does SAM, as a single entity, think? About the white paper? About seven day working? About waiting times? The President and Vice President will lead a Core Policy Group which will meet at least once a month to decide on Society policy and draft policy statements after considering members’ opinions and the needs of patients.
What are acute medical professionals experts at? How can the Society prove that acute professionals are better equipped to work on an AMU than a generalist? How can we assure those coming through the new acute medicine curriculum will be the preferred candidate? Council members will commission and collate research that will prove the worth of the AMU and AIM trained staff. They are also writing job / person specifications to be put forward to the colleges and the NHS which will highlight skills specific to acute medicine.
How can we increase the Society’s income? Should SAM push for more pharmaceutical sponsorship? It was decided that while the new pharmaceutical report (A Guide to Acute Medicine) should clarify how important acute medicine is to pharma other funding avenues must also be explored. Council members will be researching the possibility of developing management courses, gaining charitable status and selling the SCE abroad.
Also actioned; researching the possibility of regional representation, continuing work on building an AMU database, organisation of an ‘expert’ communications group, work on the curricula, redraft the definition of acute medicine.
And there we have it, five and half hours of debate cut to a few brief paragraphs. If you have an opinion on Society strategy or would like to help in some way, please do email us at firstname.lastname@example.org.
The fourth in the series of acute care toolkits from the Royal College of Physicians (RCP) has been produced in collaboration with the Society for Acute Medicine (SAM). The toolkit focuses on changes to the organisation of care, working practices and medical rotas to ensure a consultant physician is available to review acutely ill patients on the acute medical unit (AMU) 12 hours a day, seven days a week.
The toolkit provides practical guidance to senior hospital managers and clinical staff on how to organise acute medical services to ensure that the 12 hour consultant presence delivers consistent high quality care to acutely ill patients.
The guidance includes answers to key questions including:
- How many consultants are required to provide a daily 12-hour presnce on the AMU?
- How many patients should a consultants be expected to review during their shift on the AMU & how long should this shift be?
- How should consultant working & support service be organised in order to provide high quality patient care every day of the week?
On 1st June, in his role as Director of the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Northwest London, SAM’s own Professor Derek Bell interviewed the Health Secretary Andrew Lansley on how he feels the new government can drive forward improvements to the NHS.
The interview is summarised below. For a full transcript see here.
Professor Bell: We know much about evidence based medicine, but less about evidence based implementation. How does the WP and bill reflect this and help solve the problems?
Andrew Lansley: In the NHS we didn’t have too much evidence on the service we are providing – but we want to know about the quality of service we are providing so we can monitor that.
We published the Atlas of Variation in December – and there were huge variations from 1.6 per cent to 5.8 per cent average for mortality following bowel cancer surgery. We know the publication of data drives improvements in outcomes – we need an evidence base and clinical leadership to drive this.
Professor Bell: What is your view on how to establish more effective, timely data for quality improvement?
Andrew Lansley: Some of it can be very contemporary – we’ve extended the reporting of healthcare acquired infections and we are doing this on a weekly basis, and expanded it – and the rate had dropped so we know that’s working.
So we’re shifting from NHS level data where months and months later we get the results, where now we’re getting patient experience data on measures like when someone presses the call button did people respond quickly enough – we are publishing this data in a straight forward way.
Professor Bell: How do you think patients and the public can get involved in the co-design of services, and generally be much more systematically integrated into improving quality, including the improvement of patient experience?
Andrew Lansley: We need to ensure that patient involvement in their own care is built into how the NHS works. Consortia and networks need to do more to involve patients. We need to make sure they are integral to how they work.
David Tucket wrote about the meeting of experts – the expert is the patient about themselves. If you want to design a really good stroke service you need patients because we need to know what services they are expecting and how we deliver them – it is about the needs and expectations of patients, and that is where the legislation will help them and help to integrate services.
Professor Bell: How do the proposed plans and new structures within the WP and bill balance collaboration and competition within the context of knowledge sharing and cross service collaboration?
Andrew Lansley: It is just about making sure you get the right service for patients. Now the patients themselves demand more involvement in the decision about who provides their care and what treatment they receive – does that give rise to competition, yes but as a means to an end, not an end in itself. I don’t know any healthcare system where clinicians don’t experience competition in the quality of their services they provide.
Professor Bell: Improvement Science is an emerging field to help establish a stronger basis for improvement. What are your views on the development of Improvement Science and the role of research in improvement?
Andrew Lansley: It is not for me to tell the NHS how it should apply the latest evidence on how to secure these improvements. David Cameron and I have been clear what we want in terms of outcomes for patients but we would let the NHS decide for itself how it would deliver it.
The key is leadership. When I sent to King’s Fund – I explained it is leadership at every level and closer to patients.
Professor Bell: Within our research programme, local LINks have helped drive improvement projects. Looking ahead to Healthwatch, how do you think this dimension of involvement help influence and improve research for improvement, and what are the differences with LINks?
Andrew Lansley: They should be the link to the CQC, and they should be directly linked in to what patients say about their care. They should have the ability to input into the Commissioning Board nationally and the consortia locally. They should be able to look at the needs of the local people in their area, alongside the local council. Health Watch should be able to say from a health perspective what we need to do to respond to the needs of local patients.
Professor Bell: Specifically Re: academic input into commissioning, with the new commissioning agenda how do you perceive the academic community contributing effectively to this and make the most of the new landscape?
Andrew Lansley: It seems clear to me from talking to people at academic health science centres that if you want to be the best providers of healthcare, putting research and innovation alongside clinical practice is essential. If commissioners are looking at getting the best outcomes they will work with more research based organisations to innovate.
Thursday May 5th, 300 delegates descended on Bristol, some clutching posters, some steadying their nerves before presenting, all excited about a programme that crammed in the good, the bad and the clinical.
Professor Derek Bell started things off with a ‘call to arms’, it is time, he said, for acute medicine to embrace seven day working, the current system is unacceptable. Evidence presented – drawn from several studies – showed that seven day working lowers morbidity and mortality rates, improves patient experience, lowers length of stay and reduces rates of hospital acquired infections.
Steve Webster, Deputy Chief Director of North Bristol NHS Trust,looked at the issue from the employer’s perspective. He said that although seven day working could cost the NHS its health benefits could be vast.
While the consultants present tried to adjust to the idea of once more working regular weekends the conference moved on to the subject of stroke. SAM Secretary, Mark Holland, really enjoyed this session. He said: ‘Dr Baldwin gave a solid performance updating the audience on contemporary stroke medicine while Dr Renowden gave an excellent talk on what can be achieved through intervention, not only was her talk excellent but her passion for her subject was inspiring.’
That afternoon we moved from the neurological to the respiratory where our excellent speakers – Dr Martin Plummeridge, Dr Nick Maskell and Dr Ben Marshall – covered acute severe asthma, pleural effusion and pleural disease and tuberculosis.
After more coffee and pastries we were on the final stretch; ‘other emergencies in the AMU’. Dr Harsha Gunawardena opened with the diagnosis and treatment of vasculitis and was followed by Dr Martin Walker on the subject of organ donation. He focused particularly on tissue donation as it is a procedure that can be carried out on the AMU. Professor James Neuberger concluded the afternoon with an engaging talk on managing the sick transplant patient.
Friday morning dawned with a flurry of quick-fire oral presentations chaired by SAM President Dr Philip Dyer. For Dr Alice Miller, SAM Trainee Representative, this was the best part of the conference. She said:‘It was really fantastic to hear about the work being done in units around the country, and most of the presentations were of excellent quality.’
Presentations included a look at peripheral venous lactate as a prognostic indicator, non-invasive ventilation bundles and the effect of introducing an electronic GP referral system. Dr Declan Byrne ended this busy morning session with his study on increasing waiting times in the ED and mortality. He showed that there was an approximate threefold increase in mortality rate as wait time increased from less than 2.5 hours to greater than 9 hours.
Cooperation and collaboration were highlighted in the following session which looked at how acute medicine works with other specialities. Dr Charlotte Cannon put forward the case for the acute doctors, Liz Lees for the acute nurses and the brave Dr John Firth (Renal Consultant) spoke about it from the specialty perspective. Rachel Matthews was on hand to provide the patient’s perspective.
It was a lively discussion, and especially interesting to be able to hear from such a range of perspectives. Dr Firth’s hospital has introduced daily ward rounds with the all the specialists joining acute doctors to enable speedy diagnosis and improve patient care. However, in Ms Lees experience too many specialists could be a problem in itself. In some cases a dependency on specialist nurses develops resulting in a patient who has a nurse for every condition but little idea what exactly was wrong with them.
Some delegates were unable to attend the specialty session as they were busy enjoying the parallel trainee session. The speakers chosen by Dr Alice Miller and Dr Tim Bonnici were given the task of inspiring the young doctors and they didn’t disappoint. Dr Bonnici was particularly impressed with Jonathon Fielding. He said: ‘He laid out a challenging uncompromising vision of how the NHS will need to adapt to survive with a tighter budget. ‘
After another lunch of lovely little things the final session was upon us: ‘Practical challenges on the AMU’ chaired by Dr Mark Holland. Dr Gareth Greenslade was, painfully funny on the topic of pain management and for Dr Holland his presentation was the best of the entire event: ‘He had lots of learning points, all of them practical. He was a joy to listen as well.’The last two speakers may have had a hard act to follow, but they were unruffled by the challenge, both entertaining and informative. Dr Stephen Hughes, Vice President of the British Society of Gastroenterology, told us what to do when the endoscopy is normal before Dr Mike Stroud answered the question ‘to feed or not to feed?’
And it was over, all too soon. The delegates left, some clutching at posters, some feeling somewhat lighter after a successful presentation, all having been inspired in some way, large or small.
Dr Chris Roseveare summed it up: ‘As always the Spring meeting provided a great opportunity to network and meet with colleagues; it’s always reassuring to hear that the issues we face in our own units are shared across the country.’
We hope to see you in September, for even more of the same!
The Society is keen to develop its communications as the membership sees fit. Did they agree that SAM and acute internal medicine should have a higher public profile? Did they want more regular news updates? And if so, how did they want to receive their news? The communications survey answered all of these questions and proved extremely helpful in forming the Society’s new communications strategy.
Over 70 per cent of members considered it moderately or very important that the Society has a high media profile and over 50 per cent do not think SAM is generating enough media coverage. Members rated ‘policies related to acute medicine’ as the most important issue the Society should be campaigning on, followed by patient care, acute medical training and staffing levels. Suggestions on how to raise the Society’s profile ranged from ‘get on TV!!’ to publicising research, AMU statistics and guidelines or involvement in health campaigns.
As noted in the performance survey highlights Council members are already researching the possibility of supporting a public health campaign and looking into the possibility of an Acute Medicine Awareness Week, and although yet to get on TV SAM’s concerns about the coming consecutive bank holidays did receive generous media coverage (see here). As AIM is still such a new speciality there are few AMU-specific statistics to publish, although the Society will soon be launching the Acute Internal Medicine Clinical Indicators, the new measure for monitoring all AMUs.
Over 50 per cent of members were very or extremely interested in receiving a Society newsletter, while a further 24 per cent were moderately interested. The majority indicated they would like a quarterly edition. Even more popular was the idea of a regular news round-up with over 80 per cent of the membership stating they were very or extremely interested, the majority asked to receive such a round-up automatically every month.
The first issue of Acute News, SAM’s official newsletter, is in development and will be released after the Spring Meeting. To begin with it will be sent electronically. The news round-ups will be available on the website, published every Monday. After working on these round-ups it was found that monthly emails would not only be very long, but much of the news featured would be considerably out of date. If you would like to receive the round-ups weekly via email please contact email@example.com
Members were also keen to see a discussion forum on the SAM website, over half indicated they were very or extremely interested. This is a definite possibility, especially if a few members volunteer to moderate the content, if you’re interested in doing so email firstname.lastname@example.org.
It was suggested by members that the Society should have a Facebook page and a Twitter feed, the Society now has both. For SAM, health, and policy news just search for acute medicine on Facebook or follow our Twitter feed, @acutemedicine.
SAM commissioned the performance survey with the aim of finding out how the members thought they were doing and to identify areas where they could improve.
The majority of members – 61.2 per cent – indicated that they were fairly satisfied with what the Society provides, while a further 27 per cent said they were very satisfied. They are also happy with SAM’s performance in the areas of education and training, networking and internal communication, over 80 per cent of members rated the current service as fair or good (with the majority picking good).
Areas such as research and external communication were flagged as needing improvement and already the Society has begun work to address this need. SAM’s new Communications and Marketing Executive is working with the Council to raise the profile of the Society and, more importantly, the issues it believes affect patient care (see results here). The Council is also developing plans to raise the money needed to fund bigger and better research.
It’s clear that members would like to see SAM involved in health campaigns, over 50 per cent said they were very or extremely keen while a further 32 per cent were moderately keen. Suggested topics included raising awareness of conditions such as sepsis, stroke, meningitis or campaigning about alcohol or smoking related diseases. The Society is looking into possible campaigns to support, and if members have any specific suggestions please email email@example.com. Acute Medicine Awareness Week is currently in the embryonic stages; however, again, any ideas here would be welcomed.
A recent SAM survey found that many hospitals have no plans in place to ensure a high standard patient care during the Easter and Royal wedding bank holidays. During the eleven days from the 22nd April to 2nd May, there will be only three normal working days in numerous NHS trusts.
As SAM President Dr Philip Dyer said: “My hospital has only recently recovered from the Christmas holiday season, and now to face this… people still get ill on bank holidays, and yet the services are hugely depleted.”
After surveying Society members it was found that although 86 per cent of members would be happy to work on the day of the Royal wedding only a fraction had been asked to do so. Over half of members reported that they knew of no specific plans to negate the effect of these bank holidays in their hospitals and although most believed that additional services (such as radiology) would be required, few indicated that their hospitals would be providing these.
As Dr Dyer noted: ‘It is essential that hospitals start to plan for this period; consecutive 4 day weekends will have a major impact on patient care’.
After issuing a press release, the story was picked up by the Telegraph, the Independent (i edition), the Daily Express and medical news websites Pulse, onmedica and Medical News Today.
Just a couple of weeks after SAM highlighted this issue NHS Scotland announced its Be Ready for Easter campaign, noting that after Christmas, Easter is the health service’s busiest time and urging people to prepare by stocking up on medications and checking opening times for their local pharmacy and GP surgery.
Thank you to all of those who participated in the survey regarding a new logo for the Society. We’ve had an excellent response from the membership with nearly 400 responses. 69% of you preferred to stick with the existing logo so we are now taking steps to refresh it and bring it up to date.
You may be aware that the Secretary of State for Health plans to abolish the 4-hour Emergency access target from April 2011. The council of the Society for Acute Medicine along with other National groups is concerned about this proposal as we feel this will adversely affect the quality of care for acute medical patients.
We believe the points listed below are pertinent:
- Acute Medicine developed as specialty to improve the quality of care for patients admitted to hospital as a medical emergency
- Over the last 10 years there have been significant improvements in the speed with which patients are moved to a hospital bed following attendance in the Emergency Department. A key component in this improvement has been the development of Acute Medical Units and the speciality of Acute Medicine.
- Virtually all acute hospitals in the UK now have an AMU, and more than 80% of patients admitted to hospital as emergencies require initial treatment by a multidisciplinary team on the AMU that can provide high quality care to medical patients in the period following their admission. Delaying this would have an adverse impact on their care.
- It has been suggested that the 4-hour target has had a detrimental impact on patient care due to difficulties with initial assessment and treatment in this time period. However there is little evidence to support this assertion indeed published evidence demonstrates that overall <0.05% of breaches are for clinical reasons. The key is to ensure patients are moved promptly from the emergency department into a ward area where high quality care can be delivered in an environment that provides comfort, safety, privacy and dignity. Current evidence shows that a delay in reaching medical specialty opinion and beds correlates significantly with mortality. The Acute Medical Unit and the acute medical team are ideally placed to provide such care for patients. The report of the Acute Medicine Task Force in 2007 emphasised the improvement in patient care that would result from the development of acute medical units as the ‘hub’ of acute medical care within all UK hospitals1.
- It has been suggested that the increase in the number of patients admitted to hospital for less than one day indicates a rise in ‘inappropriate’ hospital admissions. In reality this increase is likely to reflect a reduction in length of hospital stay as a result of improvements in the process of care on the AMU. Published data have demonstrated the benefits of an acute medical consultant presence within an AMU in reducing hospital stay for patients admitted as emergencies2. Advances in the provision of ‘ambulatory’ care have enabled patients who would previously have required a prolonged hospital stay to be managed in a community setting. Ambulatory care is a key component of the curriculum for training in Acute Medicine and most AMUs have developed an ambulatory care unit to enable provision of this service3.
- We know that the 4 hour target has an evidence base that demonstrates an improvement in the speed with which patients are assessed and treated. There are no other evidence based quality measures defined for the undifferentiated patient who presents with acute medical illness that can readily replace this target. In addition SAM raised this important issue as part of the National Consensus Conference4.
The council for the Society for Acute Medicine supports the principle whereby quality is placed at the forefront of urgent care. However, we feel strongly that the beneficial effects of the 4-hour target must not be lost. It should be remembered that the 4 hour target was originally a patient-driven initiative. Abolition of this time-based measure may allow inefficiency to flourish at a time when optimum use of resources will be so important.
The SAM council is keen to engage in discussions on how quality can be ensured within this challenging environment and thus we have written to the Secretary of State for Health for Health and are canvassing support widely. If you would like to send me any comments please do not hesitate and send them to firstname.lastname@example.org.
Dr Philip Dyer
- Acute Medicine Taskforce. Acute medical care. The right person, in the right setting – first time. Report of the Acute Medicine Task Force. 2007. The Royal College of Physicians.
- McNeill GBS, Brahmbhatt DH, Prevost AT and Trepte NJB What is the effect of a consultant presence in an acute medical unit? Clinical medicine 2009; 9: 214-218
- Ian Scott, Louella Vaughan, Derek Bell. Effectiveness of acute medical units in hospitals: a systematic review. International Journal for Quality in Health Care 2009; Volume 21, Number 6: pp. 397–407
- Bell D; Douglas L. (Jan 2009). What are the appropriate standards for acute medicine?. Br J Hosp Med (Lond). 70:S26-S30.