Blog Section

SAM Benchmarking Audit

20th June is an important day in the SAM calendar as it is the date of the Second Society for Acute Medicine Benchmarking Audit (SAMBA 2013), which is once again being organised by Dr Chris Subbe, Dr David Ward, Dr Ivan LeJeune and Dr Charlotte Masterton-Smith.

This is a vital opportunity to document the fantastic work which is going on in Acute Medical Units up and down the UK, in a one-day audit of Acute Medicine practice. Last year over 30 AMUs took part and the results were presented at the SAM Spring meeting in Coventry and will be published in the next edition of the Acute Medicine journal. The names of all the units who participated will be listed in the journal.

We are keen to involve even more units this year; all the information and resources you will require can be found by clicking here.

More

Consultants and higher speciality trainees in acute medicine survey

The importance of ‘generalism’ in the future of in-patient care in the UK has been highlighted in a number of recent publications. Later this year the Royal College of Physicians of London is planning to publish the report of its Future Hospital Commission, in which continuity of consultant care will be a key theme. A number of potential solutions are likely to be proposed to increase the numbers of physicians able to provide a holistic approach to patient care.

To this end we would be very grateful if you would respond to the attached survey which is aimed at current acute physicians (those consultants spending over half of their clinical time working on the AMU) and ST3+ trainees in Acute Internal Medicine. The questions are designed to establish what you are doing currently and how you see your career developing in the future, in the light of the changing service needs in hospitals.

The survey should take only a few minutes to complete and we are very keen to get as high a response as possible to help to inform the response that SAM produces in the ‘generalism’ debates which are going to start during the coming months.

Please click here to access the survey.

More

Acute News – Winter 2012 Edition

Click here to see Acute News’ winter edition.

Acute News brings you the most up-to-date events from the Society for Acute Medicine and other medical stories. This winter’s newsletter includes articles on our seven-day, 12-hour a day consultant presence on the AMU report which was published in partnership with the Royal College of London; acute medicine abroad, falls and fractures and articles for trainees, nurses, pharmacists and AHPs.

Comments, feedback and suggestions for future newsletters are welcome and should be emailed to acutemedicinecomms@gmail.com.

More

Safety warning on the use of acetylcysteine

A safety warning was issued yesterday by the Commission on Human Medicines (CHM) on the use of acetylcysteine for the treatment of acute paracatemol overdose.

The commission has made the following recommendations. The licensed indication for acetylcysteine is now:

  • Paracetamol overdose irrespective of the plasma paracetamol level in circumstances where the overdose is staggered or there is doubt over the time of paracetamol ingestion; or
  • Paracetamol overdose with a timed plasma paracetamol concentration on or above a single treatment line joining points of 100 mg/L at 4 hours and 15 mg/L at 15 hours monogram, regardless of risk factors of hepatotoxicity.
  • An increase in the duration of administration of the first dose of intravenous acetylcysteine from 15 minutes to one hour.
  • Removal of hypersensitivity as a contraindication to treatment with acetylcysteine.
  • The provision of weight-based acetylcysteine dosing tables for adults and children.
  • Provision of a Technical Information Leaflet (TIL) for healthcare professionals in every pack of acetylcysteine, which gives more detailed instructions on the preparation of acetylcysteine infusions for administration.

More information is available on Medicines and Healthcare Regulatory Agency website including a number of useful resources.

More

Acute News – SAM Summer 2012 Newsletter

Click here to see Acute News’ summer edition.

Acute News brings you the most up-to-date events from SAM. This summer edition includes articles on “how to market yourself as an acute physician?” on page 5, “Acute Medicine Awareness Day: Tales of Success” on page 3, “Consultant-led AMU, what difference can it make?” on page 5 and “Introducing Nick Scriven” on page 4.

Comments, feedback and suggestions for future newsletters are welcome and should be emailed to acutemedicinecomms@gmail.com.

More

Quality Standards in Acute Medicine

The Society for Acute Medicine is commited to delivering the highest standard of practice and patient care. The Quality Standards for Acute Medical Units document was published on the 20th of June 2012. PDF available here .

The Quality Standards document is intended to complement the Quality Indicators which have been in use by a number of Acute Medical Units since January 2011.

 

More

President's Spring Email Update May 2012

With summer just around the corner many SAM members will no doubt be hoping for a few months of respite – however brief this may be! SAM remains busy as ever – this email is designed to update you on some of the activity which we have undertaken since our last communication in March.

Dublin Conference

The 25th SAM conference, held in Dublin on 3-4th May was attended by over 350 delegates, mainly from the UK and Ireland; the meeting opened with a plenary presentation from the Presidents of the Royal Colleges of Physicians of London and Ireland and continued with a broad range of topics over the two days. Evaluation has been extremely positive, with over 95% of delegates rating the conference as ‘excellent ‘or ‘good’. We have received a number of very helpful comments and suggestions regarding future meeting programmes which will help the conference committee in their planning. We are hoping to continue the relationship we have developed with the Irish Acute Medicine programme and hope that many of our new Irish members will join us at our future meetings. For those who were not able to come to the meeting there will be a more detailed meeting summary in the SAM Summer Newsletter, which will be out next month.

6th International Meeting, Manchester, 11th-12th October 2012

Plans are well underway for our 6th International meeting, which will be held in the Manchester Conference Centre in October. This year we are planning symposia on heart failure and ambulatory care, as well as a broad range of other topics relevant to acute physicians. We have a number of high profile International speakers on the faculty, as well as experts from across the UK. Registration and abstract submission is already open. We will have considerably more space for poster display at this venue than was available in Dublin, where we could only accommodate 64 posters out of a very large number of high quality abstract submissions. There will also be oral presentation sessions for those abstracts which are deemed to be of particularly high calibre; we would like to encourage more submissions from nurses and allied healthcare professionals, as well as from junior doctors. Booking early will enable you to take advantage of the ‘early bird special’ discounts, which will help ease the burden on the study leave budget. We have applied for 12 CPD points for the meeting, which should provide good value for money.

Acute Medicine Awareness Day 20th June 2012

A large number of AMUs have already registered their participation in this event but it would be fantastic if even more of you can get involved. Information on how to do this can be found on the website, or you can contact our communications officer, Claire Charras, by email at acutemedicinecomms@gmail.com. This is a great opportunity to raise the profile of your Unit within your own hospital, and to raise some money for your Unit’s charitable fund. We are hoping to improve public awareness of the benefits which an AMU can provide, by highlighting some of the excellent work being done by AMUs across the UK. If you have not yet nominated your Awareness Day ‘champion’ please discuss this with your teams and register your unit by completing, and returning the forms available on the website. We will send you an information pack and some merchandise to help you to run your events on the day.

SAM Outstanding Achievement Award

At this year’s Spring conference we announced the launch of this award which is aimed at nurses, allied healthcare professionals and doctors in training. The award is for the individual who has undertaken a project which has made a major contribution to the development or practice of acute medicine. Details of how to enter are on the website and our intention is to present the first of these awards at the autumn conference.

‘A Day in the Life of AMU’

For those of you who have not yet responded, a reminder that the SAM research and audit group would like to invite all AMUs to take part in this national Acute Medicine audit project

Please clink on this link for more details: https://www.surveymonkey.com/s/DayInTheLife_Registration

New Faces on SAM Council

We are sorry to lose Alice Miller from SAM council following her excellent 2 year term as Trainee Representative. Alice is one of a growing number of Acute Medicine trainees who has been appointed to a consultant position this year, and we wish her well. Her replacement, Kirk Freeman joins Amy Daniels as the other SAM trainee representative. Kirk and Amy’s contact details can be found on the SAM website. Also joining us is Nick Scriven, Acute Medicine consultant from Calderdale Hospital, who joins Council after being elected, unopposed, to the role of Medical Non-Trainee Representative. James Allen was re-elected to his role as Pharmacy representative.

Claire Charras is providing maternity leave cover for our Press and Communications Officer, Sarah Hunter-Argyle, who we are hoping to see again in the autumn.

Following discussions at the recent Council meeting we would like to appoint a website lead who would develop and chair the website subcommittee and report directly to SAM council. Further details of this position can be found on the website and expressions of interest should be made to Mark Holland, SAM Secretary, by the end of June.

Use of Social Media by SAM

Many of you have already started ‘following’ SAM on Twitter and ‘liking’ us on Facebook. With the help of our Communications team we are dragging ourselves into the 21st Century by using these social media sites to keep members updated with relevant news. I am slowly learning that this is a fantastic way of disseminating information widely and the more of you who get involved, the wider we can spread awareness of acute medicine. For those of you who are familiar with Twitter, we are @acutemedicine, and you can follow ‘hashtags’ #SAM, #Acuteaware, and #SAMManchester to keep updated.

News from the Royal Colleges

SAM is well represented at the Royal College of Physicians of London (RCPL) and our former President and Education Subcommittee chair Mike Jones is the Vice President of the Edinburgh College. I have been attending the RCPL council and Acute Medical Care committee, on behalf of SAM, and have been able to contribute to recent discussions in relation to ‘Generalism’ in hospital medicine. The RCPL has established a commission ‘The hospital of the future’ to examine this and other issues, and SAM will be participating in a number of their work streams. The commission is due to produce its final report in Spring 2013, and I will keep you updated with progress. In my view, general medicine is a core component of the work of an acute physician; dual accreditation with AIM and GIM will provide the acute physicians of the future with the necessary training and experience to provide immediate and on-going care for ‘general medical’ patients admitted to hospital as emergencies.

Quality indicators and Standards

A number of AMUs have already started gathering and submitting data relating to the quality indicators which are published on the SAM website. Following discussions at the SAM Dublin meeting we have made some minor changes to the wording around this issue, although the key indicators remain the same.

Our full Quality Standards document, developed in conjunction with the West Midlands Quality Review Group, is nearing completion. We hope to be able to launch this on Acute Medicine Awareness day, June 20th 2012, and will be working with the department of Health to ensure that this is incorporated into commissioning guidelines which will be produced in the autumn.

7 Day Working

SAM is producing a toolkit with the RCPL on how 7 day working can be delivered in an AMU. Some of the details around implementation were discussed at the meeting in Dublin and sparked considerable debate, emphasising the variations in models of working across the UK. It is clear that many Units are already making great strides towards the goal of a 7 day 12 hours presence in the AMU; continued engagement of dually accredited GIM / specialist physicians in the acute medical take is going to be vital in order to achieve sustainable 7 day rotas in all hospitals. The toolkit should be published later in the summer. Along with Mike Jones, I will also be representing acute physicians on the Academy of Medical Royal Colleges’ commission on 7 day working, due to hold its first meeting shortly, which will be reporting directly to the Department of Health.

NICE Guidelines

The draft Headache guideline is out for consultation and as a NICE Stakeholder organisation we have an opportunity to contribute to this; the guideline can be accessed by the following link: http://www.guidance.nice.org.uk/CG/Wave23/2/Consultation/latest

If you would like to contribute / comment on this please use the comments proforma available at the following link: http://www.guidance.nice.org.uk/CG/Wave23/2/Consultation/latest/CommentsForm/doc/English and return this to us at sam@rcpe.ac.uk so we can collate responses.

Responses need to be received by NICE by 7th June so please return your comments to us by the end of May.

Other Meetings

I would like to highlight two meetings being organised by the Royal College of Physicians of Edinburgh which may be of interest to SAM members:

The ACUTE KIDNEY INJURY: UK Consensus Conference, will be held on 16-17 November at the Royal College of Physicians of Edinburgh; abstracts for poster presentation are invited – deadline 31 August 2012. For further details contact Margaret Farquhar, m.farquhar@rcpe.ac.uk or visit the website: http://tinyurl.com/cewlewd

The RCPE is also hosting a one-day gastroenterology symposium on 2nd November; further information from Christine Berwick, c.berwick@rcpe.ac.uk or via the website: http://events.rcpe.ac.uk/events/146/gastroenterology

Acute Medicine Journal

The next edition of Acute Medicine will be coming out in June. If you have recently changed address please contact the SAM administrator, Monika Smekot at sam@rcpe.ac.uk to ensure that we have the correct details for you.

Chris Roseveare

President , SAM – 21/05/2012

CR1

More

Message from the President

Dear Colleague

Winter has been as busy as ever on the AMU, and although spring has now officially arrived, the pressure shows no sign of abating. Spring is a busy time for SAM as well, with our 25th meeting now only two months away. This email should bring you up to date with all the activities which we have been engaged with over recent weeks, and some of our plans for the coming months.

The Health and Social Care Bill

Thanks to all of you who completed the survey which we circulated last month regarding this issue. The results of this are published on the website and this has informed our position statement. I attended the Extraordinary General Meeting at the Royal College of Physicians of London (RCPL) last Monday and contributed to the debate by providing comments on our survey. We will await with interest the results of the survey which is currently being conducted by the RCPL and in the meantime I have written to the Secretary of State for Health highlighting the specific concerns of SAM members.

Quality Indicators

A number of members responded to the email regarding their readiness to gather data for the proposed AMU Quality Indicators and I am grateful to those of you who have already sent in data form their own units. There are clearly a number of challenges associated with gathering data of this type and the indicators may need to be refined to ensure the correct balance between data accuracy, ease of collection and appropriateness as true markers of quality. There is a workshop planned at the spring conference in Dublin to discuss these issues further, and in the meantime we would encourage other units to start collecting and recording these data locally. Data collection proformas and a spreadsheet for data entry can be obtained by emailing sam@rcpe.ac.uk

Seven Day Working

The first draft of the toolkit for seven day working on AMU has been written and will be published later in the spring. The toolkit, entitled ‘Implementation of Seven Day Consultant Working on the Acute Medical Unit’ is being a co-authored with the RCPL and will be the fourth in the Acute Care Toolkit series. The document will incorporate recommendations on implementation of best working practices identified in the SAM / RCPL survey. This issue will also be discussed further at a workshop in Dublin in May. (SAM Position Statement on Seven Day Working).

Atrial Fibrillation Study

Many thanks to all who participated in the national study: ‘A day in the life of Atrial Fibrillation’ run by the Acute Medicine team at Imperial College and circulated by SAM.  The organisers of the study have asked if members of SAM could complete this very brief (4 question) follow-up survey.

This is to ensure that all participating units have received acknowledgement and to enable the organisers’ records to be updated. Even if you did not participate or have already received acknowledgement, the organisers would be very grateful if you could indicate this on the survey. Please note, all survey data will remain anonymous. If you have any queries regarding this please address these to the lead investigator, Dr Anjali Balasanthiran: ABalasanthiran@imperial.ac.uk

Acute Medicine Awareness Day

The 20th June is getting closer – for those who missed the previous emails this has been designated as Acute Medicine Awareness Day; we are hoping that as many Units across the UK will participate in events to raise awareness of the speciality and to raise money for their AMU charitable fund. Further information on how you can get involved can be found on the SAM website. If you have not done so already, please nominate an Awareness Day champion and pass their contact details on to our communications team (acutemedicinecomms@gmail.com). We are hoping to send out information packs to participating units in the near future. The more units get involved the mo

 National Institute of Clinical Excellence

SAM is a stakeholder with NICE and we are asked to contribute to the development of many of the guidelines being produced. Consultations are currently in place for the following guidelines which can be accessed by the links below. If any of you would like to contribute to these please complete the relevant comments proforma (available via the links below) and return to us at sam@rcpe.ac.uk at least one week before the listed deadline. We will collate responses and submit a combined response from SAM.

Colorectal cancer quality standard
Deadline: 5pm on Thursday 22nd March.

Stable angina quality standard
Deadline: 5pm on Thursday 22nd March.

Neutropenic sepsis guideline
Deadline: 5pm on Wednesday 28th March.

Acute Medicine Journal

The spring edition of the Acute Medicine Journal will be mailed shortly. If you are a full member of SAM and do not receive your edition by the end of March please emailsam@rcpe.ac.uk with your current postal address so that we can ensure you are sent this and that our mail database is up to date. Please note that non-medics and trainees paying the reduced membership fee do not receive the journal; if you would like to upgrade your membership to ensure you receive this in future please email the SAM office as above.

Ambulatory Care

Many SAM members are actively involved in the delivery of ambulatory care on their Acute Medical Units. This year ambulatory best practice tariffs are being introduced to incentivise the delivery of  ambulatory care by providing additional revenue if patients with certain conditions can be discharged without overnight stay. Details of the relevant conditions can be found by clicking on the this link and going to p56 of the 2012/2013 PbR guide.

The NHS institute is also looking to update their Directory of Ambulatory Care which includes details of conditions which may be suitable for management in this way. If any SAM member would like to contribute to this please contact Vincent Connolly at:Vincent.connolly@stees.nhs.uk

Conferences

The Spring SAM conference in Dublin on 3rd-4th May looks like being a great success; delegate numbers are already up on last year, so please book in as soon as possible to ensure your place. The deadline for abstract submissions has been extended by 1 week, but must close on 9th March to enable enough time for review of those submissions and to enable authors to be informed in good time.  The autumn conference this year will be the sixth International Conference and is being held in the International Conference Centre in Manchester on 11-12th October, so put these dates in your diary!

Chris Roseveare
President, SAM

 

More

Health and Social Care Bill Survey: Results

Summary of Key Results

No of responses: 215

Analysis:

94% do not support the Health and Social Care Bill in its current form.

93% believe the Society should adopt an official stance on the Health and Social Care Bill, of these;

* 3% believe our official stance should be to support the bill in its current form.

* 49% believe our official stance should be to work with the government and the Royal College of Physicians to secure improvements to the legislation.

* 48% believe our official stance should be to issue an official statement indicating that the bill should be withdrawn.

Full Results of Society for Acute Medicine Member Survey

Introduction

The Health and Social Care Bill has attracted considerable debate over recent weeks. A number of healthcare organisations have adopted a formal position in relation to this issue. There have been calls from the Royal College of General Practitioners, British Medical Association, Royal College of Nursing and many other groups for the Bill to be withdrawn. The aims of this survey was to establish whether members of the Society for Acute Medicine would like the Society to adopt a formal position in relation to this issue and, if so, to guide what form that position should take.

Method

The survey was circulated to all 1032 members of the Society for Acute Medicine by email on 6th February, via a link to Surveymonkey. Further reminders were sent on 13th and 17th February. The survey questions are listed in the results section. In addition respondents were asked to identify their job title and in which part of the UK they worked. Free text comments regarding suggested improvements to the legislation were also invited. All responses were anonymous.

Results

215 responses had been received by 7pm on 19th February.

182 respondents indicated that they worked in England; 136 (63%) were consultants or career grade doctors and 68 (32%) were doctors in training; the majority of the remaining 5% were nurses.

The survey questions and responses were as follows:

  1. 1. Do you support the Health and Social Care Bill in its current form?

Yes: 13 (6%)

No: 202 (94%)

  1. 2. Do you believe that the Society for Acute Medicine should adopt a formal position in relation to the Bill?

Yes:                199 (92.6%)

No:                 16 (7.4%)

  1. 3. If yes, which of the following approaches would you be most likely to support?

(total 207 responses)

  1. To support the Bill in its current form?    6 responses (3%)
  2. To work with the Government and Royal College of Physicians of London to secure improvements to the legislation?         101 responses (49%)
  3. To issue a statement indicating that the Bill should be withdrawn?  100 responses (48%)

 Summary

Although only 20% of the membership had responded to the survey at the time of writing, the results indicate that Acute Physicians have significant concerns regarding the Health and Social Care Bill in its current form. Only a very small minority of respondents indicated that they supported the current proposed legislation and only 3% would wish SAM to take this approach.  The remainder were equally split between those who would like the Bill to be withdrawn completely and those would like improvements to the legislation.

The free text comments indicated that such improvements would need to be substantial to satisfy many of the respondents’ concerns.  There was a strong collective view that major structural reorganisation of the Health Service was inappropriate during this time of financial pressure. Significant concerns were also expressed regarding the dangers of fragmentation of acute care pathways as a result of greater competition between providers; acute physicians clearly recognise the importance of greater integration between services to ensure safe and effective care of acutely unwell patients.

Chris Roseveare

SAM President 19/02/12

 

 

More

SAM's One Thousandth Member

The end of 2011 was an auspicious time for the Society as after over ten years in existence it welcomed its one thousandth member, Dr Vivek Sharma. Dr Sharma – who won a free ticket to either of SAM’s 2012 meetings – told Acute News how he believes the AIM training programme could be improved.

Dr Sharma trained in general medicine in India and moved into acute medicine five years after coming to the UK in 2004. He says: ‘I joined SAM as a consequence of being a trainee in acute medicine just before my ARCP this year. I do think that it is good to be part of SAM. It gives a sense of belonging to the speciality and encourages one to think about it constructively.’

As a trainee Dr Sharma feels that to provide comprehensive acute medical care trainees’ postings should more accurately reflect the experience they most need to gather. He says: ‘At present the skills training is left for the trainee to organise. This is difficult as different trusts/departments work in a different manner. Therefore, posts should be created or modified to provide these skills. In my opinion the following should be a mandatory inclusion in the rotation:

A three/six month training in anaesthesia with the specific aim to be airway trained, a CT/MRI interpretation module specifically designed for acute medicine, basic ultrasound and US guided procedures, an echocardiography module for acute medicine (maybe something like FEEL module for intensive care) and finally, a SAM app for android/iphone – this would have guidelines/calculations/help useful in acute medicine.

More

SAM's Seven Day Working Policy Statement Launched

In November the Society launched its policy statement on seven day working for consultants in acute medicine.

Acute illness is a seven day problem, with patients just as likely to suffer over the weekend as during the week and this has led SAM to endorse seven day working in all acute medical units. To provide seven day working there must be a consultant on the AMU for 12 hours a day, seven days a week.

The evidence that patients are more likely to die if they are admitted over the weekend has been rising with the recent Dr Foster report finding that there is on average a 10 per cent rise in mortality for those admitted to A&E over the weekend.

Dr Chris Roseveare, President of the Society for Acute Medicine, says: ‘The Society believes that patients deserve the same high quality consultant-led care irrespective of the day of the week on which they are admitted to hospital’

The policy statement has been developed in order to encourage our members to work with their employers to provide this. In some trusts seven day working could be achieved by adapting current rotas and job plans.

Dr Chris Roseveare: ‘This problem must be addressed now; patients’ lives are being put at risk. Investment will be needed to provide adequate numbers of consultants in some hospitals, but additional costs should be offset by greater efficiency, improved quality of care and shorter hospital stay for patients.’

To read the policy statement in full please click here.

More

Introducing YAMS; the Yorkshire Acute Medicine Society

Dr Hannah Cooper explains why she felt the need to create a regional acute medicine society, and how she made it a success.

‘As the specialty training representative for West Yorkshire I identified a clear need for more acute medicine training days after feedback from trainees. The need for an SpR forum had also been raised at SAC level. Dr Joe Hogg, an acute medicine consultant in Mid Yorkshire with close ties to respiratory medicine, informed the committee of regional respiratory evening meetings that were held four times a year. They consisted of specialty specific hot topic presentations, case presentations and discussion. We felt that these successful meetings provided an ideal template on which to base similar meetings in acute medicine; thus YAMS (Yorkshire Acute Medicine Society) was formed.

Our plan was to have two meetings in the first year and then, if successful, extend this in subsequent years. Our aims were numerous. We wanted to provide specialty specific training sessions to run alongside the general internal medicine (GIM) training days and SAM meetings. We wanted to provide a forum where our acute medicine trainees could present cases and topics in a regional setting, create a network which would facilitate discussion on issues and increase awareness of opportunities for senior trainees and provide our members with an opportunity to keep their skills and knowledge up-to-date.

We were very grateful to secure sponsorship for the first YAMS meeting, which we planned to hold in early September, from Boehringer Ingleheim. They agreed to pay for hot food and drinks for the meeting.

We decided to include two ‘hot topics’ in acute medicine and then have a session aimed at trainees specifically. We secured expert speakers to discuss the mental capacity act and ambulatory care. For the trainee session we recruited senior trainees to present how they had established their specialist skill training for the benefit of the new cohort of trainees starting in August. We were very keen that we could develop the format of these meeting based upon feedback received.

The inaugural YAMs attracted twenty-five trainees and consultants and received positive verbal feedback on the night. We also asked for written feedback that would enable us to reflect on the meeting and develop YAMS further. Suggestions included trainee-led case presentations with other specialists providing support and also alternating location between West and East Yorkshire. We are already planning for our second meeting which will be in February 2012.

In the future we are aiming to increase the number of meetings to four per year. We will also look to engage other allied health professionals in acute medicine to create a multi-disciplinary forum. We will look to acute medicine trainees in the region to lead case presentations and help with the organisation of YAMS. We hope that YAMS will continue to grow successfully and be a real asset to acute medicine in Yorkshire.’

More

Rachel Wicks; SAM's first AHP Representative

The SAM Council’s first AHP Representative, Rachel Wicks, tells us why we must raise awareness of acute medicine among allied health professionals (AHPs).

‘AHPs represent a small proportion of members of the Society. Despite this they are a vital part in the decision making process for patients within an acute medicine pathway to ensure holistic and high quality care is provided. I feel it is important to raise awareness of acute medicine amongst AHPs for a number of reasons.

By seeing acute medicine as a distinct speciality it allows AHPs to define a clear role for themselves within AMUs. It also allows us to recognise the complex clinical reasoning skills and fast decision-making required that is often not utilised to the same extent within other clinical fields. By having a higher perception of our role in acute medicine, it will facilitate greater involvement of AHPs in strategies to develop the field and establish our role within forums such as SAM.

The challenge at present is achieving this awareness. This can be done through a variety of methods but will ultimately depend on how involved the AHPs are currently in your unit. Maybe your unit could discuss the speciality specifically as part of team discussions, or you could work with your workplace to ensure acute medicine is seen as a specialist field by all clinicians. Maybe you could get involved in the Acute Medicine Awareness Day on 20th June 2012. An easy step would be just to ask your AHP colleagues if they even know the society exists and let them know that AHPs can get involved. This year is the first time AHPs have been represented on the council for SAM and as this gives us an opportunity to become more involved in the field of acute medicine, it is important that we seize it.’

More

SAM comment to BBC Article: Ambulances 'facing regular delays at A&E'

Dr Chris Roseveare comments on an article on the BBC website (13.12.11) which highlights the increasing delays ambulance staff are experiencing when handing patients over to the care of A&E.

Dr Roseveare says: ‘This is a huge challenge for Acute Medical Units (AMUs) as well for Emergency Departments, particularly at this time of year. Having to wait on an ambulance trolley in a hospital corridor for any amount of time is undignified and potentially unsafe for patients. AMUs need to ensure that bed capacity is made available early in the day before the expected surge in arrivals. Although the numbers of admissions varies from day to day, the surges are often predictable. It is essential to be proactive and not reactive – senior staff working in acute medical units need to use their influence with the hospital management team to create space before a queue develops.’

More

SAM comment on Telegraph article: "New doctors feel unable to treat seriously ill patients"

Dr Chris Roseveare comments on an article in today’s Telegraph (13.12.11) which highlights research which found junior doctors feel ill-prepared to manage acutely unwell patients.

Dr Roseveare says: ‘This is yet more evidence of the need to provide adequate support and supervision for newly qualified doctors, 7 days per week. Recognition and management of acutely unwell patients is complex and requires experience. Ten years ago the majority of emergency care would have been provided by very junior doctors. The development of the speciality of acute medicine means that patients admitted to hospital as emergencies should expect to be seen by a consultant soon after their arrival on the Acute Medical Unit (AMU). There is evidence that patients admitted at weekends are more unwell than those admitted on weekdays. Acutely unwell patients deserve the best quality care, provided by experienced doctors, 7 days per week.’

More

“I would love to see acute medicine in the US”

Renowned expert in pulmonary hypertension based at Duke University, Professor Vic Tapson, gave Acute News his verdict on how far SAM has come.

‘I think Chris [Roseveare] and Derek [Bell} and Philip [Dyer], the whole gang, have done a really good job on moving this specialty along and what I love about the specialty is its focus on the first 24 hours,’ Vic told Acute News at SAM’s international conference in September. ‘It’s a novel idea, and a good one. I would love to see something like this in the US. I would like to think in academic hospitals that we do a pretty good job when someone comes to the ED but again once you’re admitted then there is a reduction in the concern about the acuity so I like the concept that the first 24 are very important. And I think the acute teams here do a wonderful job.’

Vic gave the keynote address on the Thursday of SAM’s meeting; ‘Recognising Pulmonary Hypertension in the AMU’ and although he admits it may not seem like the kind of condition acute medics really feel they need to know well, he is keen to emphasize its importance.

‘It’s the same problem everywhere, it takes a year and a half to make the diagnosis, here in the UK and the US, anywhere, which is bad. It is predominantly a disease of young women, women in the prime of life, they get this bad disease and either die from it or are badly disabled from it, that’s why pulmonary hypertension deserves a mention. With pulmonary hypertension all you get is shortness of breath, you don’t have a fever, you may not have any risk factors and when you listen to heart you may not hear anything at all, so it is a very tough diagnosis.’

Vic is a big fan of SAM’s meetings, he doesn’t just present and fly, he attends other talks and uses the opportunity to meet the delegates. He was particularly impressed by the number of young professionals who attend.

‘This is a young specialty,’’ he noted, ‘it’s a young, enthusiastic, up-to-date group. It’s good for me, I get updated and I like being around the enthusiasm of the young people. I get invited to different things and this is one thing I would love to come back to, they do a really nice job.’

More

Trainee Update

December 2011

New trainee representative

In the recent SAM elections, there were three nominations for trainee representative, and we are pleased to announce that Kirk Freeman was the successful candidate. Kirk is an ST6 trainee in the Wales Deanery, and will be taking over from Alice when her term ends in May 2012. He will also be helping out over the next few months while Amy is on maternity leave.

SAM conferences

Thanks to all of you who joined us at SAM’s 5th International Meeting at Imperial College in London at the end of September. As usual, there was excellent attendance by trainees from all corners of the country, many of whom actively contributed by displaying posters and speaking at some of the parallel sessions.

If you were unable to attend, you can find copies of the conference presentations (including those from the trainee session) on the SAM website – just go to www.acutemedicine.org.uk and click on the Past Conferences bar on the right of the homepage.

The next meeting will be held at the Radisson Blu Hotel in Dublin on 3rd and 4th May. You can register for this meeting, and submit your abstracts, through the SAM website as usual. Our plan for the trainee session at this meeting is to hold a forum about Acute Medicine training, and specialist skills training in particular. Members of the SAM council and the Acute Medicine SAC present to give information about skills training and answer any questions you may have. We hope this will be a productive session, so please start formulating your queries now.

Certificate of completion of training wording

In September the GMC finally resolved the CCT wording issues that have been troubling us for the past year or so. They have now accepted that those of us on the 2007 GIM (Acute) curriculum should have our qualification in Acute Medicine formally recognised. The table below shows the CCT wording for each curriculum currently in existence:

Curriculum title Wording on CCT
Pre-2003: GIM CCT in GIM and subspecialty of Acute Medicine
2007: GIM (Acute) CCT in GIM and subspecialty of Acute Medicine
2009: AIM single certification CCT in AIM
2009: AIM & GIM dual certification CCT in GIM and AIM

If you followed the 2007 GIM (Acute) curriculum and have been awarded a CCT in GIM only, you can apply to the GMC to have this changed to include subspecialty of Acute Medicine. Please contact Cathy Williams at the GMC (cwilliams@gmc-uk.org) in the first instance.

We appreciate that this issue has caused considerable upset to some of you, but hopefully we have now reached a satisfactory endpoint.

Curriculum news

Both the AIM and the GIM curricula have been recently been updated by the JRCPTB. The changes are due to be ratified shortly by the GMC, and once this has occurred, the updated curricula will be visible on the ePortfolio. The changes include some new common competences on the GIM curriculum, most of which will also transfer to the AIM curriculum as well. Acute kidney injury has also been added to the AIM curriculum as a new “top presentation”. In addition, there will be some amendments in the procedural competences section, in line with recent changes in the CMT curriculum.

Trainees are always concerned that curricular changes will require a lot of extra work, but on this occasion, it is unlikely that any additional training will be needed to fulfil the new competences.

In the future, the JRCPTB will undertake yearly rolling curricular updates rather than performing a major curriculum rewrite every three years. Trainees within the final 18 months of their training will be exempt from any major changes.

Assessment news

The JRCPTB are also working on some alterations to the assessment structure for medical trainees of all grades. Workplace based assessment templates will be redesigned to allow more feedback to be given, and the numbers of assessments required will also be changing. More information can be found in the recent JRCPTB newsletter:

http://www.jrcptb.org.uk/SiteCollectionDocuments/JRCPTB%20Newsletter%20Oct%202011.pdf

Along with these changes, ARCP decision aids will be updated, so that it is clear to trainees exactly what is expected of them at each stage of their training. In addition, the ePortfolio is being streamlined to make things easier for both trainees and their supervisors. We will let you know when we have more news from the JRCPTB – but for the moment, please keep working to the current frameworks.

Amy Daniel                amy_dan@hotmail.com

Kirk Freeman              k.freeman@doctors.org.uk

Alice Miller                 alice.miller1@nhs.net

SAM trainee representatives

More

SAM in the DAM

University Manchester Team

On 16th October 2011 a small team from University hospital of South Manchester (UHSM) took part in the Amsterdam Marathon
and 8K.

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.

More

Survey on Clinical Quality Indicators for Acute Medicine

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.

More