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!