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Acute Medicine Awareness Week 2019

Acute Medicine Awareness Week 2019

 

The Society for Acute Medicine’s 8th Acute Medicine Awareness Week is going to be taking place week commencing Monday 10 June 2019 in all the acute medicine units throughout UK. Units are advised to choose any day that is convenient for them within the week for the celebration of everything acute medicine.

 

Registrations for the Awareness Week are now open! To register, please complete the registration form here and return this to Elin Andersson, administrator@acutemedicine.org.uk, to register your participation for the week. Please tell us what date you have chosen to celebrate everything Acute Medicine in your department. 

 

Please click here to download your AMAW19 resource pack.

 

If you are looking for any ideas of what to do please look at the activities through the link below which were organised by SAM members in previous year.

https://www.acutemedicine.org.uk/sam-events/acute-medicine-awareness-day/

 

This year Acute Medicine Awareness Week is been organised in collaboration with takeAIM Fellows. Please visit our website, http://www.takeaim.org.uk/ for everything Acute Medicine. 

 

 

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SAMBA19 – 27 June

SAMBA19 – 27 June

SAMBA19 registration is now open! Please use the form at the end of this post to sign up and take part.

For Trusts that have more than one hospital, please register each hospital site separately. Also, you can specify if you want to be the administrator for your unit, which gives you direct access to the results of SAMBA19, as well as the ability to create additional log ins for members of your SAMBA team. You will be sent a link to start uploading your unit data two weeks before the audit date of 27th June 2019.

You will find the Caldicott Guardian form, a SAMBA19 protocol, a SAMBA19 How to Guide and Masterlist below.

Protocol SAMBA19

Caldicott Approval SAMBA19

SAMBA 19 How to Guide

SAMBA19 Masterlist

We will release the final version of the patient form very soon.

Please start arranging your SAMBA19 data collectors for the 27 June 2019 and ensure that your Caldicott Guardian has approved data release. Also, your local audit team should be made aware and approve of SAMBA19 using your usual local permissions.

Any queries, please let us know at samba@acutemedicine.org.uk

Dan Lasserson, on behalf of the SAMBA19 team.

 

SAMBA19

Please fill in this form to register to participate in SAMBA19. Once you have registered, you will receive your SAMBA database log in details via email within 2 weeks. Thank you very much for your support of SAMBA!
  • Data Protection

    Your registration details will be stored securely within a database at the Royal College of Physicians of Edinburgh (RCPE) in compliance with the General Data Protection Regulation (GDPR) and accessed only by administrative staff working on behalf of the Society for Acute Medicine (SAM) for the purposes of administering your participation in the Society for Acute Medicine Benchmarking Audit (SAMBA) 2019. Your registration details will be shared with the company Net Solving for the purpose of generating the account you will use to access their data collection website. The Society of Acute Medicine will, from time to time, send you email communications relating to your participation in SAMBA 2019. You may also be contacted by email about possible involvement with the next Society for Acute Medicine Benchmarking Audit.
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FAMUS shortlisted for BMJ award

The FAMUS group were delighted to be short-listed for a BMJ award in the Education category. This is an excellent recognition of the work the team have done to bring point of care ultrasound to trainees across the UK.

The nomination recognises the work the team have done in bringing FAMUS from a neat idea of a few enthusiasts, to the recognised curriculum and standardised teaching materials (including famus.org.uk, the e-LFH module and our YouTube channel) that we have today.

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SAMontheMOOR – 10-11 October 2019

SAMontheMOOR – 10-11 October 2019

Welcome to SAMontheMOOR, being held on the 10-11 October 2019 at the Harrogate Convention Centre. 

The conference offers 12 CPD points and will update your skills and knowledge in many areas of clinical practice within acute medicine that you encounter daily. Our conferences are open to all members of the multidisciplinary team who work in acute and general medicine, ranging from doctors in training through to senior consultants, nurses, physiotherapists and pharmacists. The conference offers an entirely independent programme, based on the most recent research and development in acute medicine and has been designed by a multidisciplinary team who work at the front door in acute and general medicine on a daily basis.

View the Programme 

Registration now open!

To register, please click here.

Abstract submission

Abstract submission is open until 29 July 2019.

For more information, view the Call for Abstracts.

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Senior medic says NHS performance figures “frankly appalling”

Commenting on the release today of NHS performance data for April, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“Today we have seen frankly appalling performance figures which are going largely unnoticed. The NHS should be embarrassed by them.

“There are massive issues across the health service despite Easter and good weather which should provide relief but instead it has been busiest April ever with the worst performance in just about any urgent metric.

“The “solution” can’t be to ease targets – we urgently need clinically-led reviews of services and engagement from the secretary of state who is today is tweeting about cricket when he really needs to get his eye on the ball.

“The comments today by NHS England on zero tolerance for patients staying longer than six hours in emergency departments are also ill-judged.

“It is fine rhetoric but could cause serious issues for hard-pressed trusts with potentially unstable patients being moved to unsafe areas just to beat a clock.”

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SAMontheTYNE Posters

Click on the links below to view the posters displayed at SAMontheTYNE:

Audit & Quality Improvement Posters

AQI 01: A Closed Loop Audit on Transforming Clinical Guidelines at Dudley Group NHS FT

AQI 03: Assessing and Improving the Quality of Fluid Balance Charts in Medical Wards at a Tertiary Care Hospital in London

AQI 11: Identifying and Improving Delays in Processing ‘To Take Out’ (TTO) Medications

AQI 17: Intravenous Iron Infusions on AMU – Are They Being Used Appropriately?

AQI 19: Management of Homeless Patients in Hospital

AQI 22: Patient flow through the AMU: A Quality Improvement Journey

AQI 23: Point of Care Ultrasound in Acute Kidney Injury: Rapidly and Reliably Images at the Point of Admission

AQI 24: Reducing Malignant Ascites Admissions to Ambulatory Care Using Indwelling Peritoneal Catheters

AQI 25: Risk Stratification in Neutropenic Sepsis using the MASCC Score: Can Patients be Discharged Earlier?

 

Case Report Posters

CR 01: A Case of Paraneoplastic Brainstem Encephalitis Associated with Non-Cutaneous Merkel Cell Carcinoma

CR 03: CRPS Presenting on the AMU: An Under-recognised Cause of Limb Swelling

CR 04: Gitelman Syndrome with Resistant Symptomatic Hypokalaemia Persisting Post Miscarriage

CR 05: I Smell a Rat

CR 06: Interpretation of INR with Rivaroxaban in the Context of Acute Liver Failure Due to Hepatitis A

CR 08: Pseudoangioedema – An Important Presentation to Recognise

CR 09: Pseudohamoptysis – An Uncommon Presentation of a Common Symptom

CR 11: Surviving the Un-survivable

 

Education Posters

E 01: SAM: A Thematic Analysis

E 02: A Chronological Review of Simulation Training for Medical Trainees Across the Norther Deanery

E 04: Acute Simulation for Foundation Doctors: Is it Worth the Effort?

E 07: Communicating Confidence:  Peer Led Small Group Teaching to Improve Confidence in Approaching the MRCP PACES Communication and History Taking Skills Stations

E 08: Improving Education Via the Acute Medicine (AIM) Team; A Pan Medical and Multidisciplinary Approach

E 11: Delirious Tea Trolley Teaching!

E 12: Registrar Readiness – What Does our Medical Admissions Unit Have to Offer?

 

Research Posters

R 02: Early Warning Scores: A comparison of the National Early Warning Score and a Mono-Parametric Early Warning Score in a UK Hospital

R 03: Feasibility Study of Ambulatory Care for Adult Patients (AMBUCAP) Admitted to the Medical Wards of a Tertiary Referral Hospital in Botswana

R 07: Streamlining Inter-Hospital Communicate by Reducing Avoidable Switchboard Delays

R 08: The Diagnostic Accuracy of Sepsis Scores, and Clinical Bedside Judgement (CBJ) in Sepsis in the ED Using an Expert Panel Reference

R 11: Validation Study of Age-Adjusted D-Dimer Cutoff Levels to Exclude Venous Thromboembolic Disease

 

Service Organisation & Design Posters

SOD 03: Audit to Assess the Use of the Royal London Hospital (RLH) Ambulatory Care (AC) Service in Providing Admission Avoidance and Supportive Discharge to Patients

SOD 05: Development of an Ambulatory Care Pathway for Hyperglycaemia

SOD 06: Empowering the AMU to Transform End of Life Care

SOD 09: Improving the Care of In-patients with Acute Kidney Injury in an Acute Hospital

SOD 11: Paramedic Direct Referrals to Senior Clinician: Is this the Way Forward? A Pilot Project in Acute Medicine and Ambulatory Care at the John Radcliffe Hospital

SOD 12: Reducing Delays in the Discharge Process on an AMU

SOD 13: Surgical and Medical Acute Recovery Team (SMART) – A Collaborative Approach with the Community Enabling Patients to Receive Hospital Treatments in the Community

SOD 14: The Cold Truth about ‘Winter Pressure’ in a District General Hospital. A Retrospective Analysis of Mortality by Month of Admission to an AMU

SOD 17: The Specialist Physiotherapist in Ambulatory Emergency Care: Developing a Frailty Pathway in the Ambulatory Unit at the John Radcliffe Hospital, Oxford

SOD 18: The Weekend is a Weak-End for a District General Hospital. A Retrospective Analysis of Mortality by Day of Admission to an AMU

SOD 20: When WILL the Doctor See You?

SOD 21: Winter Pressures: A Novel Approach to a Well-Known Problem

SOD 22: The CPSP (College of Physicians and Surgeons Pakistan) Scholarship Program and The Dudley Group NHS Foundation Trust – A Symbiotic Relationship

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Top doctor warns bank holiday could break hospitals

A top doctor has warned the upcoming bank holiday could break NHS hospitals that are already struggling with winter levels of pressure.

Dr Nick Scriven, president of the Society for Acute Medicine, said the system had not recovered from an “Easter hangover” – and the three-day weekend could “exacerbate things further”.

He said medics from across the country had reported unprecedented numbers of attendances at emergency departments over the past two weeks, with some seeing around 80 more patients than normal for this time of year.

He warned that many hospitals had been on high alerts levels and any outbreak of norovirus combined with the usual post-bank holiday influx of severely unwell patients who had delayed seeking help could be “disastrous”.

“I am deeply concerned about the reports I am hearing from colleagues across the country and indeed what I am seeing on the ground,” said Dr Scriven.

“It felt like things were improving but the four-day Easter caused havoc, with hospitals that had only just been recovering from another difficult winter back to square one.

“Some hospitals are seeing up to 80 more patients in emergency departments than normal for this time of year and the bank holiday weekend could really stretch services and put a huge strain on drained staff.”
He added: “Most hospitals have now decommissioned any additional winter resources, so any slight rise in pressure through a norovirus outbreak or influx of severely unwell patients could prove disastrous.”

Dr Scriven said while the public could help in some way by utilising care in the community over weekends – such as GP hubs, 111 for non-emergencies, minor injuries units and pharmacies – responsibility rested with the government and NHS leaders.

“While the senior leadership continues to trot out the line that the NHS is busier than ever, they can’t escape from the reality that there is a staffing crisis, social care funding has been inadequate and bed capacity has been cut massively.”

Acute medicine receives the majority of patients admitted from A&E and helps maintain the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.

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Medics voice fears over no-deal Brexit and say uncertainty ‘already impacting care’

More than two-thirds of acute and emergency medics believe a no-deal Brexit will impact their ability to deliver care – and more than half think the ongoing uncertainty has already affected their hospitals.

The findings come from a snapshot survey conducted by the Society for Acute Medicine (SAM), the national body for the specialty which deals with immediate and early treatment of adult patients with a variety of medical conditions who present to hospital as emergencies.

Acute medicine receives the majority of patients admitted from A&E and helps maintain the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.

The UK has been given an extension to the Brexit process – which was initially due to be resolved by 29 March – by the European Union until 31 October.

In response to the question ‘Do you think a no-deal Brexit will impact on our ability to deliver acute medicine?’, 72% answered yes, 8% no and 20% were unsure, while 60% said their hospitals had already been affected.

Additionally, almost half (48%) feared a managed Brexit with a deal would still cause disruption to services, with most concern around the effect on medical staffing (37%), non-medical staffing (27%) and medical supplies (25%).

Almost all respondents (90%) said they would not change their original vote if there was a second referendum.

“We have been warning for some time now about the negative impact of Brexit on the NHS and I said recently how it has acted as a smokescreen for the government over the issues engulfing frontline healthcare,” said SAM president Dr Nick Scriven, speaking at the organisation’s two-day conference – SAMontheTYNE – in Newcastle.

“These concerns have now been reinforced by many those of those in acute medicine – doctors, nurses and support staff – and sends a message that this situation is harming the delivery of services to patients.

“In our view, it is no coincidence that we are seeing continuous poor performance – with a record low again in March – and a growing staffing crisis at the same time as the withdrawal debacle bounces from one embarrassment to the next with next to no recognition of the ongoing healthcare issues in the national media

“What is particularly significant now, given where we are at, is that a large proportion have voiced concern over ongoing events, so I would urge politicians to end their dithering and, at the very least, not make this any worse than it already is for patients and healthcare professionals alike.”

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Doctors develop standards to improve emergency outpatient care

Outpatients receiving urgent and emergency care across the NHS are set to benefit from new standards developed by two leading medical bodies.

The Royal College of Physicians of Edinburgh (RCPE) and the Society for Acute Medicine (SAM) have jointly produced standards for same day emergency care, also known as ambulatory emergency care (AEC).

AEC is a service that provides same day (outpatient) emergency care to hospital patients where they can be assessed, diagnosed, treated and are able to go home the same day without being admitted overnight.

In a report released in November, Winter 2018/19 in the NHS: The solutions, SAM called on the government and NHS leaders to “realise urgently” the potential of AEC.

The Society estimated that just a 5% increase in the number of patients who receive their first assessment and subsequent treatment in AEC could save an additional 238 overnight bed stays – equating to the prevention of 14,042 overnight admissions over the months of January and February.

As a result of SAM’s focus on AEC and data published in the Society for Acute Medicine Benchmarking Audit, AEC was incorporated into the NHS Long Term Plan and, in March, NHS England announced every major hospital will provide same day emergency care services by next winter.

“The Society urged the government in the report ‘Winter 2018/19 in the NHS: The solutions’, to look at “how much could be achieved with investment in this area” and address why the implementation of AEC units was “not standard or uniform” across the country,” said Dr Scriven.

“This was followed by the incorporation of AEC into the NHS Long Term Plan with a target of increasing the proportion of patients looked after in this way and the establishment of a joint NHSE/NHSE/specialist societies group to make this a reality by late 2019.

“Underpinning the process has been a real need for standards written by a group of experienced physicians who work in that area and are seen as subject ‘experts’.”

He added: “This is the first time that standards for AEC units have been produced and it is hoped that all providers, those writing policies and those commissioning services will adopt them as soon as possible.”

Dr Mike Jones, director of training at RCPE and a consultant in acute medicine, said:

“AEC is an important service which provides same day hospital care to patients. AEC units treat a wide variety of common conditions including headaches, diabetes, deep vein thrombosis and cellulitis.

“These joint standards by RCPE and SAM aim to define the standards that should be adopted in ambulatory emergency care units. We think that patients deserve to be seen by a doctor or a nurse promptly, and then to have the best treatment possible.

“We believe that these standards will speed-up and improve patient care and ensure that patients have clear advice on what to do if their condition deteriorates after being discharged from hospital.

“They should also reduce admissions and readmissions, free up valuable hospital beds for those patients who most need them and provide a much needed boost for our hard-pressed hospitals, the staff who work in them and the NHS as a whole. “

The standards say:

  • Patients should be initially seen within one hour of entering an AEC unit.
  • Patients will be initially examined by a doctor or nurse, and an assessment will be made based on their symptoms, past medical history and details of any medications they are taking. Patients may need to have some diagnostic tests, like an X-ray or ultrasound scan, and the aim is to get the test results to patients on the same day.
  • During the period of care under the ambulatory team, patients should have clear written instructions for if they feel they are deteriorating or if they wish to discuss concerns prior to their next scheduled visit.
  • Patients should be seen promptly and certainly within one hour by a clinician who has the capabilities to assess and investigate the patient’s symptoms and signs. This clinician should have immediate access to a more senior clinical decision maker for review when the presentation proves more complex.
  • All units undertaking AEC should regularly survey a representative and consecutive number of patients under their care. This should take the form of a short questionnaire. At least 5% of all patients should be surveyed and the total time spent in the unit for each patient should be calculated. This data should be used to improve patient care.
  • A consultant physician should be available on the hospital site day and night throughout the opening times of the AEC unit, to review AEC patients.
  • A nominated clinician from the multi-disciplinary team (MDT) should take responsibility for the overall leadership of the AEC unit to ensure there are active clinical governance and quality improvement processes and strategies.
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Hospitals working “flat out” and under “considerable strain” says SAM president

Following the release today of NHS performance data for March, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“This has been and continues to be an extremely challenging time for urgent care in the NHS which has been overlooked amid the chaos of Brexit and the smokescreen it has created, with politicians on all sides not only posturing about Europe but now also starting to position themselves for any possible elections while performance against urgent care access figures remains low.

“Although winter officially ‘finished’ on the 3 March when the NHS stopped publishing data on weekly pressures, it is still very much ongoing in our units which are under considerable strain.

“In March, the proportion of patients seen and discharged from our emergency departments was only 86.6% across the board but down at 79.5% for the Type 1 units were our sickest patients arrive at. This is marginally better than the month before and March 2018 but worse than 2017 and the last time the 95% target was met was July 2015.

“This is despite staff working their now almost routine miracles looking after more patients than they ever have before with more than two million people coming to these areas in the month representing 5.7% more people than last year but with no real extra resource to cope. In fact, the number of inpatient beds available to the system is now 10.1 per 100 people aged over 75 which is the lowest in six years according to Public Health England.

“My major imminent concern is that hospitals are working flat out at the moment and we have a looming spell of bank holidays when many support services will not be functioning, heaping up the already relentless pressure.

“Major issues remain in community care, there is a staffing crisis and trusts are being asked to care for more patients with worsening conditions – yet the Department of Health and Social Care and NHS England have been relentless in their positivity.

“It remains to be seen how the government can explain removing the four-hour access target in such a climate of recurrent failure and it must not be seen as simply changing goal posts that have been in place for very good reasons just because the system cannot achieve them to the detriment of patient care and staff wellbeing.”

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Leading medic says NHS pressures “still masked by Brexit smokescreen”

A senior medic has warned the NHS remains under “considerable strain” which continues to be “masked by the Brexit smokescreen”.

Dr Nick Scriven, president of the Society for Acute Medicine, said he had raised concerns about the effect of political distraction on hard-pressed hospitals last autumn – and his fears had played out.

“This has been and continues to be an extremely challenging time for urgent care in the NHS which has been overlooked amid the chaos of Brexit and the smokescreen it has created,” he said.

“We have seen more people attending our hospitals as emergencies than ever before with month-on-month the worst performances recorded when measuring against the four-hour emergency access target.

“Although winter officially ‘finished’ on the 3 March when the NHS stopped publishing data on weekly pressures, it is still very much ongoing in our units which are under considerable strain.”

In February, hospitals in England only managed to see 84.2 per cent of A&E patients within four hours – the lowest figure recorded.

Dr Scriven said this was against a backdrop of uncertainties around the future of the four-hour target and the NHS workforce review which has been delayed until the autumn.

“The big issues are why so many people are needing our help and how much longer can the system cope with the stresses and strains of keeping these people safe while maintaining the wellbeing of staff performing now daily miracles.

“Major issues remain in community care, there is a staffing crisis and trusts are being asked to care for more patients with worsening conditions – yet the Department of Health and Social Care and NHS England have been relentless in their positivity.

“These messages are divorced from the reality of everyday workers and the secretary of state has made an ever-increasing number of ill-judged and ill-informed comments which have done little to suggest he has the capability to improve the situation.”

Dr Scriven said clinicians and medical groups were “growing increasingly frustrated” at the health secretary’s “obsession with technology” and “disinterest” in the problems on the frontline.

“While staff have been run-ragged keeping services running under intense pressure, Mr Hancock has been making ill-informed comments about everything other than the key issues.

“He has a seemingly unfailing belief that technology is the answer to everything despite most hospital units running on IT systems that would have been considered outdated by the private sector many years ago.

“There is a general – and worrying – feeling among healthcare workers that he has managed the barely credible feet of making his predecessor in the role look knowledgeable.”

Dr Scriven said it had been made clear there was “no hope” of major issues facing the NHS being discussed or addressed until the resolution of Brexit, so urged the government to listen to the frontline.

“The health secretary’s lack of engagement with medical groups and hospitals over daily pressures impacting services is shocking.

“We as a society do not only ask to meet with those in senior leadership positions for the sake of saying we have met but because we want to work with them on trying to solve the underlying issues facing urgent medical care.”

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Senior medic says NHS leaders have “heaped pressure” on hospitals by failing to overhaul four-hour A&E target

Following today’s announcements regarding standards in the NHS, a senior medic has said NHS leaders have “heaped pressure” on hospitals during recent chaotic winters by failing to overhaul the four-hour A&E target.

Dr Nick Scriven, president of the Society for Acute Medicine, said the organisation had been calling for change since 2016.

“Back in 2016, SAM made loud and clear calls for the NHS to stop aiming only to meet the four-hour standard when it was clear a whole system approach was required,” he said.

“Ironically, the target of treating and discharging or admitting 95% of patients in emergency departments within four hours has not been met at all since then.

“It is no coincidence that, over this period, we have seen hospitals under unprecedented stress and demand – all while being unable to obtain a clearly defined picture due to a lack of appropriate and timely performance data.”

He added: “The review of the target is an opportunity to focus on a range of patient outcomes and quality standards to measure pressures and take effective action earlier – a lack of wide-ranging information heaps further pressure on already-stretched hospitals.

“We do agree that, while standards are arbitrary and quite blunt, they are useful if they are interpreted sensibly but other factors should be considered when assessing pressures and our ability to treat patients as we would like.

“These include the number of opal 4 alerts and capacity-related major incidents, daytime bed occupancy figures, numbers of patients moved to non-specialist wards and timeliness of senior clinical reviews.

“Regarding its testing and implementation it is vital to test across a broad range of hospitals across the performance spectrum and have whatever is decided on firmly embedded before any sign of autumn/winter pressures resume.”

Dr Susan Crossland, vice-president of SAM, said: “The health secretary said recently he was open to considering alternatives and our suggestion has been laying in wait since 2016.

“We will continue to make genuine attempts to improve the health service for patients and staff and hope that the health secretary’s actions back up his words and he engages in meaningful discussions regarding this emotive but essential topic.”

Acute medicine deals with the immediate and early treatment of adult patients with a variety of medical conditions who present to hospital as emergencies.

The specialty receives the majority of patients admitted from A&E and helps maintain the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.

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Senior medic says “silent crisis” persisting across NHS

Following the release of the latest winter sitrep performance data today, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“Although the recent brief window of better than expected weather might have given a slight respite to the hard-pressed urgent care areas in the NHS, figures continue to paint pictures of strain and a system on a knife-edge.

“It is nice but hardly reassuring to see overall occupancy dip just below 95% for four successive days. Worryingly, the longer stay patient numbers seem to be static or slightly worse over the season with currently 5% more patients in beds for more than 21 days than at the start of these weekly seasonal reports.

“Again, it feels as though the official response has been to normalise this by comparing data to last winter. It is, I suppose, reassuring that these figures are no worse than the last crisis but, as anyone who works on the frontline will tell you, pressures are just as great.

“Additionally, after nearly two years of unrelenting pressure there is not much reserve left to cope with anything extra. It is essential we continue to hold senior leaders to account as we deal with this silent crisis.

“This includes trusts putting in “special plans” such as “perfect weeks/months” over the next month which cynics would see as a desperate ploy to boost end of year performance data at the expense of working staff who are already on the limits even harder.”

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SAMBA18 National Report

SAMBA18 National Report

We are pleased to inform you that the SAMBA18 National Report is now available here.

SAMBA18 National Report

We hope that the report will be of use.  We have included the names of participants who were made known to us.  We would be happy to amend the names of participants if there are any errors and if so we apologise in advance; let us know if we can help.

As one round of SAMBA finishes, another begins.  Please get ready for Thursday 27 June 2019.  Over half of all UK AMUs now participate in this annual event and we look forward to more people joining us this year.

We also look forward to your comments and hope you can join us at the SAMBA sessions at our next two conferences, SAM-on-the-Tyne (May 2-3 2019, Gateshead) and SAM-on-the-Moor (October 10-11 2019, Harrogate).

For now, we hope you enjoy reading the report and once again thank everyone who contributed to the audit, which was recently quoted in the NHS Long-Term Plan.

Professor Dan Lasserson, SAMBA Lead

Professor Mark Holland, Past President to the Society for Acute Medicine

On behalf of the SAMBA Academy

 

The SAMBA18 Interim Conference Report can be found here.

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Figures show an NHS under “severe strain” – SAM president

Following the release of NHS performance data for January, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“Although there is less minor illness associated with flu this year, there are more severely ill people than last year which is putting an even bigger strain on the critical care facilities in our hospitals.

“From the weekly situation reports, adult intensive care unit occupancy is higher this year than last for the same week (85.6% v 85%), with 21 ICUs declaring 100% full even on the best day which is same as last year.

“This figure is extremely concerning as it implies that there is no more capacity in the system than last year for the very sickest people with many units full, leading to either delays in treatment or vulnerable patients needing transportation to hospitals perhaps many miles away to find the care they need.

“At the other end of the scale it is worth noting for comparable weeks that ambulance delays seem higher than last year together with virtually identical occupancy rates for general beds and, if anything, slightly higher number of beds closed due to infection.

“With the Royal College of Emergency Medicine figures showing even worse performance against the four-hour target, these figures point to a service under equally severe strain as last winter and actually paints a very different picture to the ‘mood music’ coming out weekly from the NHS.

“Any NHS worker will tell you that the stresses and strains are very real and ongoing with no let up in sight.

“Perhaps the lack of public discussion about the pressures facing us this winter reflect the reality that frontline staff grimly accept that things are tough and have no energy leftover to get agitated in the face of no real improvements over recent years of struggle.”

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Senior medic says upbeat NHS winter messages “hiding true picture”

Dr Nick Scriven, president of the Society for Acute Medicine.

I think it is fair to say that those within the Department of Health and Social Care are the only people who are happy with the whole Brexit debacle in that it has firmly deviated all attention away from the current state of the NHS.

I note with some amusement the positive spin put out every week by NHS England regarding the weekly situation reports – ‘SitReps’ – and how they claim, for example, a bed occupancy of 0.1% less than this week last year is good.

At the same time, attendances at emergency departments are higher than last year and they seem to refuse to acknowledge the effect of having nearly 2,000 beds closed at present due to norovirus and flu.

They are also seemingly oblivious to the Royal College of Emergency Medicine winter flow metrics, produced weekly, that show performance against the four-hour target in their measured trusts is the poorest ever.

The RCEM quotes “At 77.92%, performance is 3.11 percentage points lower than was the case in 2017-18 and in is, in fact, the lowest performance figure we have ever recorded in the fourth week of January” – despite a bed base that is currently up more than 3% since the beginning of winter.

My take on the SitRep data is that to try to maintain a service we have worked harder than ever in a period of concerted and continual high pressure and, worryingly, this is increasing bit-by-bit as staff tire.

We are starting to see stories in the press around pressure points, most recently the delays in ambulances coming to people’s aid. I fear these are the high profile tips of the iceberg of stress and strain on our NHS.

The relentless upbeat messages from central NHS are hiding the true picture and we again find ourselves saying that comparisons to the ‘crisis’ last year are invalid.

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