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Interface between acute medicine and critical care

After wide consultation, and as used in JRCPTB documentation the agreed definition of Acute Medicine ‘is that part of general (internal) medicine concerned with the immediate and early specialist management of adult patients suffering from a wide range of medical conditions who present to, or from within hospitals requiring urgent or emergency care’. The acute medical unit is the specialised area of an acute hospital where patients suffering from acute medical illness can be assessed and initially managed.

There has been rapid change in the organisation and delivery of care for patients with medical illnesses over the last decade and more recently since the Acute Medicine sub specialty curriculum was established in 2005. The continued growth of this area of care has been reflected by the large number of reports and recommendations that have been produced the most recent of which include The Acute Medicine Task Force Report, RCPL and the UK Consensus Conference on Acute Medicine from the RCPE.   Both provide a framework that may be used to improve care for patients with acute medical problems. These include prompt assessment by a competent senior decision maker, facilitated access to investigations, accurate diagnosis and prompt instigation of treatment wherever it may be required. In addition these documents outline the required facilities and the need for close working with other specialties, in particular Critical Care and Emergency Medicine. As a minimum AMU’s must have dedicated monitoring facilities to provide level 1 care and for larger units the need for level 2 facilities is recognized with the defined level of staffing. Acute hospital physicians and those practicing acute medical care should be equipped by training, experience and the available facilities to provide this level care for patients with acute medical problems.

The Acute Internal Medicine (AIM) curriculum reflects the need for physicians who are dedicated to providing prompt, high quality and effective management of patients who present with acute medical illness. Working within the multi-professional team and with adequate facilities it is possible for such clinicians to improve patient care and outcomes. Even given the increasing number of patients with complex and long term medical problems and associated acute exacerbations. Trainees in Acute Internal medicine need to acquire competences relevant to:

  • the prompt practical management of acute presentation of medical illness,
  • the management of medical patients in an in-patient setting,
  • the development of new patient pathways to maximise safe, effective care in the community
  • the provision of leadership skills within an acute medical unit,
  • the development of multi-professional systems to promote optimal patient care,
  • the management of patients requiring more intensive levels of care

Critical care is essential to support acute medical admissions as medical patients numerically represent the most seriously ill subgroup of patients presenting to acute hospitals with a recognised hospital mortality of between 4-5%.

The recommendations from the reports referenced above suggest that in future level 3 facilities should be co-located with the AMU and ED, i.e. within the emergency floor, especially for larger acute hospitals. Close working relationships between AIM and critical care is, therefore, essential. All AMUs require an area that provides augmented care (Level 1–2 see below) and staff with competences to deliver this level of care. In some cases level 2 facilities are already embedded within the AMU to ensure provision of the higher level of care often required for many acute medical patients at the point of entry and need. Staff working in AMUs with HDU facilities must have the necessary critical care competences relevant to their local working environment and policies.

The AMTF report recommended that AMUs develop an augmented care area (up to level 2 care) and staff with competences to deliver this level of care. Safe transfer arrangements should be in place to ensure level 3 care is accessed when required. Staff in smaller hospitals (ideally based on the AMU) will still need competences in the assessment and stabilisation of critically ill patients prior to transfer to larger critical care units.

To ensure the appropriate skills in critical care are acquired the AIM curriculum requires that acute medical trainees are competent in the recognition and management of common medical problems including shock and respiratory failure and have the associated clinical skills in haemodynamic monitoring, non-invasive ventilations, CVP line and arterial line insertion etc). Training in AIM also specifies a placement within critical care to support training in these areas. Although some critical care training maybe acquired during CMT or ACCS training the society feels that this should be supplemented by further training as an AIM speciality trainee. The development of an acute medical syllabus for nursing is planned to ensure that the multi-professional team has the necessary skills to manage level 1 and level 2 patients frequently and competently.

It is important that the Society for Acute Medicine, the professional body for AIM, continues to work closely with Critical Care to ensure that the care to patients with higher level of need is coordinated and delivered to the highest standard.

Levels of care

Level 0

Patients whose needs can be met through normal ward care in an acute hospital

Level 1

Patients at risk of their condition deteriorating, or those recently relocated from higher levels of care whose needs can be met on an acute ward with additional advice and support from the critical care team.

Level 2

Patients requiring more detailed observation or intervention including support for a single failing organ system or postoperative care, and those stepping down from higher levels of care.

Level 3

Patients requiring advanced respiratory support alone or basic respiratory support together with support of at least two organ systems. This level included all complex patients requiring support for multi-organ failure

References

Royal College of Physicians of Edinburgh. UK Consensus Statement on Acute Medicine. BJHS 2009;70:56–7.

Royal College of Physicians. Acute medical care. The right person, in the right setting—first time. Report of the Acute Medicine Task Force. London: RCPL, 2007.

The Society of Acute Medicine (UK). Recommendations for Medical Assessment (admission) Units. Edinburgh: SAM (UK), 2003.

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

Mayor S. Acute medical units reduce deaths and stays in hospital. BMJ 2008;337:a1865. (Report of: 2nd International Conference of the Society for Acute Medicine, London, 2008).

McNeill G, Brahmbhatt DH, Prevost AT et al. What is the effect of a consultant presence in an acute medical unit? Presentation at: First International Conference of the Society for Acute Medicine, Glasgow, 2007.

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In the news this week…17th of February until 23rd of February 2014

Headlines…

New chief urges rethink on workload of junior doctors. (The Herald, 17.02.2014)
Paracetamol given reprieve in NICE arthritis guidance. (Nursing Times, 18.02.2014)
Scotland bucks UK drink-related death trend. (BBC, 19.02.2014)
Combating the dual burden: therapeutic targeting of common pathways in obesity and type 2 diabetes. (The Lancet, 20.02.2014)
Patient data fears ‘scaremongering’. (OnMedica, 21.02.2014)

Other News in Brief…

Loneliness can boost risk of early death among older adults. (OnMedica, 17.02.2014)
Patients still in the dark about care.data, warn doctors’ leaders. (OnMedica, 17.02.2014)
Strategic support for struggling health economies. (National Health Executive, 18.02.2014)
NHS concordat to halve police detention of mental health patients. (Information Daily, 18.02.2014)
Alcohol-related deaths among the elderly reach highest ever level. (The Guardian, 19.02.2014)
Independent journal calls for domperidone to be removed from market after medication linked to premature deaths. (The Independent, 19.02.2014)
Lack of public defibrillators linked to heart attack deaths. (OnMedica, 20.02.2014)
Calling all geriatricians…FRAILsafe needs you!! (British Geriatrics Society, 21.02.2014)
Five minutes with…a men’s health consultant. (Guardian Professional, 21.02.2014)

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SAM Response to CEM Report

Strictly embargoed until Tuesday 8 October 00:01

The Society for Acute Medicine (SAM) response to the College of Emergency Medicine (CEM) survey results on emergency department workforce.

The College of Emergency Medicine (CEM) publishes today (Tuesday 8 October) the results of their survey looking into emergency department workforce in the UK.

Responding to the report, Dr Alistair Douglas, SAM President said: “The Society for Acute Medicine has been working closely with the College of Emergency Medicine and NHS England to find solutions to the ongoing pressures in emergency departments. A key part of the solution is to ensure that patients are moved quickly into ward beds as soon as a decision has been made that they need to be admitted to hospital.

“Unfortunately the pressure on hospital capacity means that this is often not possible and patients remain in the emergency department, adding to the pressure which the emergency department staff find themselves under. With winter rapidly approaching, we need to work quickly to resolve this problem. Earlier this year SAM, in collaboration with the NHS Confederation, the Royal College of Physicians (London) and the College of Emergency Medicine published a 10-point ‘prescription for the future’ which identifies some of these solutions.”
ENDS

Notes to the editors:

  • Acute medicine (also known as acute internal medicine) is the specialty which deals with the immediate and early treatment of adult patients with a variety of medical conditions who present in hospital as emergencies.
  • The Society for Acute Medicine is the national representative body for the speciality of acute medicine and represents around a thousand members.
  • Dr Alistair Douglas is a consultant in acute medicine and nephrology at Ninewells Hospital and Medical School in Dundee and is the Society for Acute Medicine President since 3 October 2013.

Contact:
Claire Charras
Communications and Marketing Executive
Society for Acute Medicine
07 985 49 49 65
communications@acutemedicine.org.uk
www.acutemedicine.org.uk

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Relationship between AIM and EM

The specialties of Acute Internal Medicine (AIM) and Emergency Medicine work closely together in providing care to patients with acute medical presentations. The doctors trained in these two specialties have clearly defined and specific competencies which although complementary are not interchangeable. The Colleges believe that doctors should only practise in the areas in which they have been trained and have acquired the full range of necessary competencies. Cross coverage between the specialties, therefore, can not be achieved without increasing clinical risk and would not be in the best interests of the patients served.

For doctors to practise in both specialties additional training would be required to provide the opportunity to gain all the relevant competencies. This would have to be assessed by relevant workplace based assessments and examinations to confirm that those competencies have been gained. The colleges would recommend that such doctors would be eligible for entry to the specialty register in both specialties but it would be anticipated that typically two or more additional years of training (first year during core training and second year during higher specialist training) to achieve the requisite level of recognition that would be needed in addition to completion of the relevant examinations (MRCP, Specialty Certificate examination, MCEM and FCEM).

The standards of training as defined within the relevant curricula for both Emergency Medicine and AIM have been approved by the statutory body (GMC) and the Colleges firmly believe that the employment of doctors who do not have the requisite and relevant competencies for senior roles within NHS organisations should be discouraged.

This statement has been shared with the GMC who have been pleased to note that it reaffirms the GMC requirements in relation to dual CCTs in Acute Internal Medicine and Emergency Medicine.

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Training Structure

The route to higher training in Acute Medicine is usually via either core medical training (CMT) or acute care common stem (ACCS) training. These programmes give trainees a solid grounding in the medical or acute specialties. Click here to read more about CMT and ACCS .

Higher Acute Medicine training is a four-year programme from ST3 level, which, once successfully completed, leads to a CCT in Acute Internal Medicine. Some trainees will choose to dual accredit in both AIM and General Internal Medicine (GIM), which will add about one year to the training time for full-time trainees. The figures below (taken from the AIM 2009 curriculum) illustrate the training pathway.

Diagram 1.0 shows the training pathway for Acute Internal Medicine

Figure 1: Training in Acute Medicine alone

training-figure-2

Figure 2: Dual CCT with GIM

During higher training, registrars will gain experience not only in Acute Medicine, but also in other relevant specialties. These include some of the more “acute” medical specialties (such as Cardiology, Respiratory Medicine and Medicine for the Elderly), and also critical care specialties (Intensive Care Medicine and occasionally Anaesthetics). More information about what to expect from higher training can be found in the AIM 2009 curriculum.

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In the news this week…10th of February till 16th of February 2014

Headlines…

Car smoking: MPs support ban when children present. (BBC, 10.02.2014)
NHS has to adapt to survive, says chief executive. (The Telegraph, 11.02.2014)
Thousands more could be offered statins. (NICE, 12.02.2014)
Symptoms of lunch disease frequently overlooked, study finds. (The Guardian, 13.02.2014)
Ex-M&S boss to advise NHS managers. (BBC, 14.02.2014)

Other News in Brief…

Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study. (The Lancet, 10.02.2014)
Huge rise in diabetes numbers fuels calls for action. (The Herald, 10.02.2014)
Lords challenge 7-day working plan by 2016. (Hospital Dr, 10.02.2014)
Twitter role for spreading best practice, says CNO. (Nursing Times, 11.02.2014)
Integrate health and employment services –OECD. (National Health Executive, 11.02.2014)
Staff disillusionment at new public health body, survey shows. (The Guardian, 12.02.2014)
Exclusive: Quality and quantity of student placements at risk from staff shortages. (Nursing Times, 12.02.2014)
How has the NHS workforce changed since the coalition took power? (Guardian Professional, 13.02.2014)
Restless sleep linked to pain in the elderly. (OnMedica, 13.02.2014)
Special measures trusts delivering ‘real improvements’. (National Health Executive, 14.02.2014)
Lib dems bid to make minimum nurse level law in Wales. (Nursing Times, 14.02.2014)

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Life fellowships for top UK academics at international Acute Medicine Conference

Press release: strictly embargoed until 03/10/2013 00:01

Professor Sir Ian Gilmore and Professor Derek Bell will be awarded honorary Life Fellowships by the Society for Acute Medicine (SAM) at its 7th international conference in Glasgow today (Thursday 3 October).

The awards are in recognition of the enormous contribution that both have made to the development of the speciality over the past decade. Dr Chris Roseveare, SAM President said: “I am delighted to be able to present these awards to two of the most influential figures in the Society’s short history. Professors Bell and Gilmore both played pivotal roles in establishing acute medicine as an independent specialty and their support and guidance have been invaluable throughout the past decade”

Professor Sir Ian Gilmore, former President of the Royal College of Physicians and President of the British Society of Gastroenterology said: “It has been inspirational to watch acute medicine grow and come of age over the last decade as a direct response to the needs of patients. I am delighted and honoured to be recognised by the Society that has played such a major part in that success.”

Professor Derek Bell, who was inaugural President of SAM at its inception in 1999 and was the first academic chair of Acute Medicine, at Imperial College London appointed Professor of Acute Medicine said: “Acute Medicine provides a growing platform for the delivery of high quality patient care and clinical training and I am privileged to have been part of this journey and am delighted to have honoured with the Society’s Fellowship”.

The seventh international SAM conference highlights some of the key challenges which face the National Health Service, with presentations from the authors of two of the most significant documents over the past year. Robert Francis QC, chair of the Mid Staffordshire NHS Foundation Trust Public Inquiry and Professor Tim Evans, principle author of the Royal College of Physicians’ Future Hospital Commission will both address the meeting, illustrating the important role which acute medicine and acute physicians have to play in implementation of their recommendations.

Dr Chris Roseveare will be succeeded as SAM President by Dr Alistair Douglas, consultant in Acute Medicine at Ninewells Hospital in Dundee at today’s Annual General Meeting.

Dr Alistair Douglas, consultant in acute medicine at Ninewells Hospital in Dundee, who succeeds Dr Roseveare as SAM President at today’s Annual General Meeting said: “I look forward to working with talented, dedicated hard-working colleagues within SAM Council and the greater membership to continue to highlight the need to prioritise quality care for patients who are hospitalised with urgent need for acute medical care. There are many current and future challenges in a shifting NHS but it is a privilege to be part of an organisation committed to giving a voice to often unheard patients and staff.”

ENDS

Notes to the editors:

  • Acute medicine (also known as acute internal medicine) is the specialty which deals with the immediate and early treatment of adult patients with a variety of medical conditions who present in hospital as emergencies.
  • The Society for Acute Medicine is the national representative body for the speciality of acute medicine and represents around a thousand members.
  • Dr Roseveare has been an acute medical consultant in a large teaching hospital since 1999.
  • Dr Alistair Douglas is a consultant in acute medicine and nephrology at Ninewells Hospital and Medical School in Dundee.
  • Acute medicine was recognised as an independent specialty in 2001.
  • A conference press pack can be downloaded here.
  • The Society for Acute Medicine conferences are organised by Eventage Ltd.

Contact:
Claire Charras
Communications and Marketing Executive
Society for Acute Medicine
07 985 49 49 65
communications@acutemedicine.org.uk
www.acutemedicine.org.uk

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In the news this week…3rd of February till 9th of February 2014

Headlines…

Workplace drug and alcohol problems growing concern. (OnMedica, 03.02.2014)
Giant patient records database ‘should be delayed’. (BBC, 04.02.2014)
Staffing has improved since Francis, claims Hunt. (OnMedica, 05.02.2014)
Police will have ‘backdoor’ access to health records despite opt-out, says MP. (The Guardian, 06.02.2014)
Health experts urge MPs to back car smoking ban. (BBC, 07.02.2014)

Other News in Brief…

Tobacco firms line up £500m claim over plain packs. (The Scotsman, 03.02.2014)
Labour to blame coalition for rise in cold-related A&E admissions. (The Guardian, 03.02.2014)
Experts warn of hypertension ‘epidemic’. (OnMedica, 04.02.2014)
Sale of ultra-cheap alcohol to be banned in England and Wales. (The Guardian, 04.02.2014)
Allowing patients to discriminate by race is ‘institutional racism’. (OnMedica, 05.02.2014)
Diagnosis time for common cancers reduced. (National Health Executive, 05.02.2014)
‘Slow progress’ on elderly care reforms in Scotland. (BBC, 06.02.2014)
Three-fold increase in UK insulin use, study finds. (BBC, 06.02.2014)
Hunt sets out progress on HCA plan for aspirant student nurses. (Nursing Times, 07.02.2014)
U.S warning on Scottish obesity levels. (Royal College of Physicians Edinburgh, 07.02.2014)

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Society for Acute Medicine response to Ombudsman report on sepsis

Press release: strictly embargoed until 13/09/203 00:01

Society for Acute Medicine Response to Ombudsman report on sepsis.

“Sepsis should be at the top of every acute physician’s priority list”

Sepsis is a common cause for hospital admission and many patients with sepsis will spend the first part of their hospital stay in an acute medical unit (AMU). It is critically important that all staff working the AMU have the necessary skills to recognise and initiate prompt treatment for this condition.

Dr Chris Roseveare, President of the Society for Acute Medicine said: “This document highlights some truly shocking examples where the care of patients with sepsis has fallen well below the standard which would be expected. In many cases the deficiency was a failure to recognise sepsis as the cause of the patient’s illness; delays in senior review and failure to escalate to higher dependency care were also key features in this report.

“The Society for Acute Medicine  is committed to raising standards for the care of patients admitted to hospital in an emergency, seven days per week. The importance of seven day consultant presence on the AMU and early consultant review for all patients on the AMU is emphasised in our quality standards documents and a recent toolkit launched in October 2012; many hospitals are already achieving this, while others are urgently working to expand their acute medicine consultant workforce”.

SAM is already working closely with organisations such as The Sepsis Trust and the Royal College of Physicians to help raise awareness. Recently Dr Dan Beckett and Dr Claire Gordon, two acute physicians from Scotland cycled from Edinburgh to London to help raise awareness of sepsis, using social media to highlight the key symptoms which patients need to recognise. The recent acute care toolkit: ‘The Medical Patient at Risk’, published by the Royal Colleges of Physicians and launched at our spring meeting highlights the need to use the national early warning scoring (NEWS) system to recognise a patient’s deterioration as early as possible and to ensure that appropriate monitoring and staffing is provided to meet the patient’s needs. Many of our recent conferences have featured symposia on sepsis recognition and treatment, which has also been highlighted in our Acute Medicine journal.

Dr Roseveare added: “Sepsis is a serious condition, but patients are more likely to survive if the problem is recognised and treated quickly. If we are to ensure that the failings identified in this report are not repeated we must provide appropriate training and support to all staff working in acute medical units. Sepsis should be at the top of every acute physician’s priority list”.

ENDS

Notes to the editors:

  • Acute medicine (also known as acute internal medicine) is the specialty which deals with the immediate and early treatment of adult patients with a variety of medical conditions who present in hospital as emergencies.
  • The Society for Acute Medicine is the national representative body for the speciality of acute medicine and represents around a thousand members.
  • Dr Roseveare has been an acute medical consultant in a large teaching hospital since 1999.
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Society for Acute Medicine response to RCP Future Hospital Commission

Press release: strictly embargoed until 12/09/2013 00:01

Society for Acute Medicine response to RCP Future Hospital Commission

 Caring for Medical Patients: “Acute medical units are a key part of the solution”

The Society for Acute Medicine (SAM) welcomes the Royal College of Physicians (RCP) “Future Hospital” report published today.

A key feature of the report is the further development of ‘Acute Care Hubs’ within hospitals, incorporating acute medical units (AMUs), ambulatory care and short-stay wards to ensure highly co-ordinated, efficient care of patients admitted to hospital in an emergency, seven days a week.

Dr Chris Roseveare, SAM President and member of the steering group for the Future Hospital Commission said: “The rising numbers of patients being admitted to hospitals with increasingly complex problems has placed emergency departments and acute medical units under huge pressure over recent years. This document recognises that the solutions to this will require some radical changes to the ways in which we deliver healthcare in the future. AMUs are integral to the solution but we must also ensure that high quality, co-ordinated care is provided for patients throughout their hospital stay and following discharge from hospital”.

 

The report emphasises the need for better continuity of care for patients in hospital; this is particularly important for those with complex needs and those who problems do not fit into a specific specialist category. Almost all acute physicians already have the skills and training necessary to provide ongoing care for this group of patients, and a recent survey conducted by SAM indicated that the majority would be happy to deliver this if provided with appropriate staffing and support.

Dr Roseveare added: “Acute physicians, being dually trained in general internal medicine, are ideally placed to provide ongoing, continuous care for many patient groups; however some organisations are already struggling to recruit sufficient numbers of trained consultants to provide a seven day service on the AMU, and an extension of their role will further increase this challenge. The report recognises the importance of increasing the numbers of trained ‘general’ physicians. Over the next few years, several hundred of our acute medicine trainees will become consultants with the skills to take on these roles; it is vital to ensure that we support and develop career pathways for acute physicians to ensure that this remains a popular and sustainable career choice for consultants of the future

“Sir Michael Rawlins and the Future Hospital Commission should be congratulated on producing a document which could produce substantial improvements for patient care in hospitals; turning this into reality will require clinicians to work closely with their managers, patients groups and commissioners over the coming months and years so we can ensure that the ‘hospital of the future’ becomes the ‘hospital of the present’”.

Some of the practical consideration will be discussed during an International symposium at the Society for Acute Medicine conference next month in Glasgow, which will be addressed by one of the report’s main authors Dr Tim Evans; we will be encouraging our members to attend this session and read the document carefully to determine how best to implement the changes on a local level.
Notes to the editors:

  • Acute medicine (also known as acute internal medicine) is the specialty which deals with the immediate and early treatment of adult patients with a variety of medical conditions who present in hospital as emergencies.
  • The Society for Acute Medicine is the national representative body for the speciality of acute medicine and represents around a thousand members.
  • Dr Roseveare has been an acute medical consultant in a large teaching hospital since 1999.
  • The full report is available on the Royal College of Physicians (London) website www.rcplondon.ac.uk

 

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In the news this week…20th of January till 26th of January 2014

Headlines…

We must stop searching for heroes and villains in the NHS. (Guardian Professional, 20.01.2014)
Society for Acute Medicine response to 2014/2014 National Tariff Payment System. (SAM, 21.01.2014)
Safe staff levels ‘should apply to NHS and care sector’. (BBC, 22.01.2014)
One in four hospitals records false waiting times. (The Telegraph, 23.01.2014)
Let’s not overlook what acute internal medicine has achieved, says SAM President. (SAM, 24.01.2014)

Other News in Brief…

Clegg attacks NHS mental health care. (BBC, 20.01.2014)
Identifying frailty and its outcomes. (British Geriatrics Society, 20.01.2014)
Take head injuries seriously, says NICE. (NICE, 21.01.2014)
BMI obesity measure ‘needs to be lower’ for millions in UK. (BBC, 22.01.2014)
Major new infection control guidelines focus on hand hygiene. (Nursing Times, 22.01.2014)
UK heart attack death rates much higher than Sweden. (OnMedica, 23.01.2014)
Health chief calls for reform of training given to doctors. (The Herald, 23.01.2014)
Treating patients as people says Jeremy Hunt. (Department of Health, 23.01.2014)
Stethoscope ‘may soon be obsolete’. (HSJ, 24.01.2014)
Older cancer patients ‘should not be written off’. (BBC, 24.01.2014)
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SAM response to NHS Confederation report “Emergency care: an accident waiting to happen?”

Press release: strictly embargoed until 08/09/2013 00:01

Society for Acute Medicine response to NHS Confederation report “Emergency care: an accident waiting to happen?”

Dr Chris Roseveare, SAM President said: “This document provides a stark reminder of the ongoing pressures faced by emergency departments and acute medical units across the UK. The causes of these pressures are complex and because of this there is not going to be a single, simple solution. A collaborative approach across primary and secondary care and between health and social care will be essential.

“The well-publicised staffing and recruitment crisis in emergency medicine across the UK is creating a huge challenge for many hospitals and is placing existing staff under immense pressure. Healthcare professionals working both within and outside hospitals have a responsibility to support the delivery of high quality acute care for patients, seven days per week. In some cases this may require clinicians to work differently, crossing traditional boundaries to support their colleagues in the emergency department, or to ensure the rapid transfer of patients to a speciality in-patient or community team.

“Acute medical units are a key part of the solution to emergency department overcrowding, ensuring that patients who require hospital admission are able to move rapidly into a hospital bed. However this ‘patient flow’ is dependent on a hospital’s ability to maintain spare bed capacity. Too many hospitals run at 100% occupancy for too much of the time, despite evidence that suggests that greater efficiency is achieved with occupancy below 85%. Maintaining spare capacity in hospitals, such that every day starts with empty beds in acute admitting areas, would provide a major step forward in achieving the timely admission of patients from the emergency department.”

Earlier this year, the Society for Acute Medicine, NHS Confederation, Royal College of Physicians and College of Emergency Medicine collaborated to produce a 10-point plan to ease emergency pressures. It is crucial that these are now addressed as quickly as possible.

ENDS

Notes to the editors:

  • Acute medicine (also known as acute internal medicine) is the specialty which deals with the immediate and early treatment of adult patients with a variety of medical conditions who present in hospital as emergencies.
  • The Society for Acute Medicine is the national representative body for the specialty of acute medicine and represents over a thousand members.
  • The full document will be available on the NHS Confederation website on Sunday 8 September 2013.

Contact:

Claire Charras
Communications and Marketing Executive
Society for Acute Medicine
communications@acutemedicine.org.uk
07 985 49 49 65

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In the news this week…13th of January till 19th of January 2014

Headlines…

Obesity crisis: Future projections ‘underestimated’. (BBC, 13.01.2014)
Sharp rise in spending on A&E locum doctors. (BBC, 14.01.2014)
Empowered and engaged NHS staff will provide better care. (Guardian Professional, 15.01.2014)
Welsh health service needs ‘radical’ overhaul. (OnMedica, 16.01.2014)
How big data could be used to predict a patient’s future. (Guardian Professional, 17.01.2014)

Other News in Brief…

‘Sharing data saves lives’ say charities and researchers. (OnMedica, 13.01.2014)
What can older people tell us about their experience of therapeutic exercise as part of falls prevention service?  (Ageing Journal, 13.01.2014)
Developing integrated care: what role do acute hospitals play? (The King’s Fund, 14.01.2014)
Female consultants losing out on CEAs. (Hospital Dr, 14.01.2014)
Organ donation partnership calls for family to be informed. (National Health Executive, 15.01.2014)
Passport to improve patient experience. (British Geriatrics Society, 16.01.2014)
Frontline staff to drive change on special day. (Hospital Dr, 16.01.2014)
Weight loss surgery: up to two million could benefit. (BBC, 17.01.2014)
Pharmaceutical industry joins disclosure debate. (OnMedica, 17.01.2014)

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In the news this week…6th of January till 12th of January 2014

Headlines…

Leaflet drop across England on new patient data sharing plan. (National Health Executive, 06.01.2014)
A&E: some patients visit units 50 times a year. (BBC, 07.01.2014)
UK government allowed alcohol industry to kill minimum unit price. (Information Daily, 08.01.2014)
Lack of A&E causes ‘major incident’ at Belfast hospital. (Information Daily, 09.01.2014)
“Revalidation is failing to identify NHS doctors unfit to practise”. (Hospital Dr, 10.01.2014)

Other News in Brief…

50 per cent rise in deaths from oesophageal cancer. (OnMedica, 06.01.2014)
Scots nurses spending more time with patients. (The Scotsman, 06.01.2014)
College condemns obesity surgery dispute. (Hospital Dr, 07.01.2014)
Why services aren’t working seven days a week. (HSJ, 07.01.2014)
How to treat a medical intern. (Comment is free, Guardian, 08.01.2014)
Combine treatment for moderate to high risk prostate cancer, says NICE. (OnMedica, 08.01.2014)
EASYCare Project: a new world for older people. (British Geriatrics Society, 09.01.2014)
Campaigners vow to cut sugar in food. (BBC, 09.01.2014)
Wales NHS scan and ultrasound waiting times treble. (BBC, 10.01.2014)
Gene therapy might offer hope in Parkinson’s. (OnMedica, 10.01.2014)

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Raising awareness, raising money and raising the bar for Acute Medical Units

FOR IMMEDIATE RELEASE

15 July 2013

Monday 15 July marks the start of Acute Medicine Awareness Week 2013 in hospitals and trusts up and down the country supported by the Society for Acute Medicine (SAM).

Throughout the week, acute medical unit (AMU) teams including consultants, trainee doctors, allied healthcare professionals and nurses will be taking part in activities to raise public awareness of the importance of acute medicine and their work in the AMU.

Dr Chris Roseveare, SAM president, said: “This is an important week for all staff working in acute medical units. During the past few months, the pressures on acute NHS services have been unprecedented. This week provides an opportunity for AMU staff to showcase the excellent work that they have been undertaking to improve the quality of care and experience for patients admitted to hospital in an emergency.

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Acute News Winter 2013

Acute News Winter 2013 edition is here!

Acute News brings you the most up-to-date SAM and acute medicine news. This Winter 2013 edition includes some Q&As with new faces on council including SAM President Dr Alistair Douglas, an exclusive article on the development of acute medicine in Kurdistan and a piece by Dr Mark Temple reflecting on his years as acute care fellow at the RCP London.

Comments, feedback and suggestions for future newsletters are welcome and should be email to Claire Charras, communications@acutemedicine.org.uk.

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The Society for Acute Medicine response to the Cavendish Review

FOR IMMEDIATE RELEASE

The Society for Acute Medicine (SAM) welcomes the two key recommendations supporting training and development of Health Care Assistants (HCAs) from the Cavendish Review published today.

Firstly, the document proposes a national ‘certificate in fundamental care’ and secondly, ‘development of a career framework’ for HCAs working in health and social care. Both recommendations echo early work in progress nationally.

Liz Lees, SAM nursing representative, nurse consultant in acute medicine is the author of the recent “Principles for safe patients transfer and handover in the acute medical units” (June 2013). The SAM document is written for Health Care Assistants (HCA) working in acute medical units (AMU) or in similar areas where the regular transfer of patients represents a significant proportion of HCA activities.

Liz Lees said: “A national Certificate of Fundamental Care will impact upon hospitals at a corporate training level; however AMUs will need to take responsibility for local training, induction and performance of HCAs. One way forward would be for AMUs to develop a standard creating parity of induction for HCAs which recognizes both ‘routine and advanced’ tasks carried out by HCAs within an AMU setting.

“As the report recognizes the role of the registered nurse and HCA have boundaries, which are blurring; whatever our considerations to support HCA development, patient safety must remain our central focus.”

The principles for safe patients transfer in AMU document offers a framework of best practice principles addressing requirements of safe transfers of patients from the acute medical units. The principles are based on the 6Cs developed by the Department of Health as part of the national nursing strategy for England in 2012:

  1. Competence: Are competent to undertake the transfer of the patient
  2. Compassion: Are aware of the patient’s physical and emotional needs during transfer
  3. Care: Provide effective care in line with patients current needs during transit
  4. Communication: Have received a good handover of the patients’ condition and care required
  5. Commitment: Always handover to a registered member of staff before leaving the patient at the new ward or department.
  6. Courage: Report any issues of concern with the transfer & handover process on return to their ward to participate in the continual review of service provision for patients.

Dr Chris Roseveare, SAM President said: “HCAs are a key part of every acute medical team and have a particularly important role in ensuring the safe transfer of patients out of the acute medical unit (AMU). This has been highlighted in Liz Lees’ recent report published on our website.”

ENDS

Notes to the editors:

  • Acute medicine (also known as acute internal medicine) is the specialty which deals with the immediate and early treatment of adult patients with a variety of medical conditions who present in hospital as emergencies.
  • The Society for Acute Medicine is the national representative body for the specialty of acute medicine and represents over a thousand members.
  • The President of the Society for Acute Medicine, Dr Chris Roseveare, is available for interview.
  • Dr Roseveare has been an acute medical consultant in a large teaching hospital since 1999.
  • A session will be dedicated to developing a National Standard for HCA training within AMUs at the next Society for Acute Medicine Conference.
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Response to NHS England High quality care for all, now and for future generations report.

For immediate release: 17/06/2013

The Society for Acute Medicine welcomes the publication of NHS England’s new report addressing emerging principles from the urgent and emergency care review.

These principles are in line with SAM’s commitment to seven day working for consultants in acute medical units; early recognition and implementation of National Early Warning Scores across the UK as well as our commitment to the collaboration of emergency and acute care to develop ambulatory and admission pathways which ensure safe and effective high quality care for patients arriving in hospital in an emergency as highlighted in our response to the CEM report in May 2013.

The recent challenges in urgent and emergency care highlighted in the press accentuate the pressing need to review the system as a whole. The Society for Acute Medicine believes this consultation is a step towards this which calls for seven day working in acute medical settings, a strong multi-disciplinary team and the importance of onsite acute medical units in hospitals with A&E departments.

Dr Chris Roseveare, SAM President said: “This is a step in the right direction. It is vital to stress to the important and value of AMU in reducing crowing in emergency departments. As highlighted in the Royal College of Physicians Acute Care Toolkit 6 and previous SAM research, getting the right patient in the right bed the first patient significantly relieves the emergency department and ensure high quality care for patients. The Society for Acute Medicine is urging its members to take part in this engagement period.”

Note to editors:

  • Acute medicine (also known as acute internal medicine) is the specialty which deals with the immediate and early treatment of adult patients with a variety of medical conditions who present in hospital as emergencies.
  • The Society for Acute Medicine is the national representative body for the specialty of acute medicine and represents around a thousand members.

Contact:

Claire Charras
Communications and Marketing Executive
Society for Acute Medicine
07 985 49 49 65

communications@acutemedicine.org.uk

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