Blog Section

President’s Message: SAM 10th Anniversary Year

This is an exciting time for the Society which is in its 10th anniversary year. It is opportune to remind members both present and future and other interested parties of the role of SAM.

Rule 1 of our constitution states:

The title of the Society shall be ’Society for Acute Medicine’.  Its object shall be to promote better care of patients who present with acute medical illness.  In pursuing this object the Society shall:

  • Promote education of medical, nursing and paramedical staff in Acute Medicine.
  • Facilitate and co-ordinate the collection of data relevant to acute medical assessments and admissions.
  • Facilitate collaborative research in the area of Acute Medicine.
  • Promote the creation of appropriate environments for acute medical assessments and admissions.
  • Share good practice.
  • Promote the acute care models that exist as examples of improving the management of patients with acute medical problems.
  • Provide encouragement to all members of the multi-disciplinary team that work in Acute Medicine.

The Society wishes to continue to develop and foster its multiprofessional identity and it is gratifying to have a broad spectrum of healthcare professionals involved in the society; however, we need to develop this much further.

Highlights for the society in the last 12 months:

  • In August 2009 we achieved full specialty status for Acute Internal Medicine.  The curriculum is now available on the JRCPTB website (www.jrcptb.org.uk).
  • Specialty Advisory Committee (SAC) for Acute Internal Medicine has been formed and already has had two meetings
  • 3rd International conference in Birmingham which was a great success
  • Involvement in the clinical guideline development of numerous guidelines with NICE
  • Publication of a systematic review of Acute Medical Units (AMUs) showing that they reduce in-patient mortality, length of stay and blocking of access to emergency department without increasing readmission rates, and improve patient and staff satisfaction

Up and coming highlights:

  • 4th International conference in Edinburgh
  • A paper to providing a guide to training in echo and ultrasound in acute medicine
  • As previously stated the society will continue to focus on three key areas: Consolidation, Building Capacity and Development.

Consolidation

Achieving full specialty status for Acute Internal Medicine provides a stable platform for the continued development of our specialty.  Now as an established clinical group, it is important that we do not merely consider ourselves part of the establishment, if we are to continue to grow and flourish.

A broad range of healthcare professionals, as well as Industry, increasingly recognise the importance of acute medicine.  We do, however, need the public to understand our role in the same way that Intensive Care (ITU) and Coronary Care (CCU) are established terms and understood.  As part of our consolidation and building our identity, it is imperative that as a group we adopt the preferred term for our units, the Acute Medical Unit (AMU), within the hospitals we all practice.

Building Capacity

The new 2009 Acute Internal Medicine curriculum for medical trainees is complete and was a major component in the drive to achieve full specialty status.  It comprehensively documents the competencies required for acute medicine trainees and importantly, reflects the views of both trainees and trainers.  This pioneering piece of work establishes the standards for other specialties and positions acute medicine well to become a leading career choice for junior doctors.  Our specialty must now ensure that we deliver the curriculum to enable our trainees to become the highly skilled doctors we desire.  In addition we need look to supporting nurses, allied healthcare professionals and pharmacists to develop acute medicine as an important part of their portfolio development.

Development

It is important that we ensure the growth of the specialty for all professionals involved or related to the delivery of high quality acute medical care.  I also recognise that we must continue to develop and support our existing members and ensure that the Society fosters links with all relevant clinical specialties.  Specifically the Society will continue to develop our conferences and meetings, to provide an excellent resource for continuing professional development and to support the importance of informal networking and sharing good practice.  The Society for Acute Medicine is regularly contributes to national working parties and committees including those from the Royal Colleges.  This further enhances the reputation of the Society and increases the opportunity for members to contribute on a national stage.

The Society has a number of active work stream programmes in place, including the development of a national database – SAMURAI.  This work builds on other recognized national databases and is in line with our goal of producing quality standards for acute medicine.  This is essential if we are to continue to show evidence of improved care for patients presenting with acute medical conditions.  We are also aligning our research portfolio to reflect both the patient case mix and the current strengths of society members.  We soon will be producing a document to help the training in echo and ultrasound for acute physicians.

Dr Philip Dyer

President

Nicholo Machiavelli ‘The Prince’ 1515:
for it happens in this, as the physicians say it happens in hectic fever, that in the beginning of the malady it is easy to cure but difficult to detect, but in the course of time, not having been either detected or treated in the beginning, it becomes easy to detect but difficult to cure

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Health and Social Care Bill

This statement has been produced to explain the position of the Society for Acute Medicine (SAM) in relation the Health and Social Care Bill.

The Society for Acute Medicine (SAM) does not support the Health and Social Care Bill; this position reflects the views of 94 per cent of respondents to a recent survey of our members. The care of acutely ill patients is dependent on close integration of a variety of hospital, community and social care services. It is our view that the proposed changes will fragment the acute care pathways which are essential for delivery of high quality, safe and effective treatment to patients who require hospital admission. Substantial modifications to the Bill would be required to allay the concerns expressed by our membership; if significant changes cannot be secured by amendments to the legislation we believe that the Bill should be withdrawn to prevent long-lasting damage to the NHS, and to the care of patients with acute illness.

Chris Roseveare, President

March 2011

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Membership Benefits For Trainees

SAM is the representative body for all professionals working in Acute Medicine. As a medical trainee, the benefits of joining the society include:

  • Access to the most up-to-date information about training and curriculum matters
  • The opportunity to influence your training, and even the practice of Acute Medicine nationally, through society representation
  • Multiple opportunities for ongoing professional development, including reduced fees for the biannual SAM conferences
  • Demonstration of commitment to the specialty

You can find more information on membership and membership rates here.

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

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

Headlines…

Thousands pledge to ‘do something different’ for NHS. (BBC, 03.03.2014)

Health service is ‘unsustainable’, NHS director warns. (The Telegraph, 04.03.2014)

Consultants’ experience needs to be better recognised. (OnMedica, 05.03.2014)

Ageing society means ‘fundamental shift’ in healthcare delivery. (National Health Executive, 06.03.2014)

Patients should be told when mistakes are made, senior doctors say. (The Guardian, 06.03.2014)

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The Society for Acute Medicine response to RCPE UK Medical Consensus on Urgent Care

For immediate release

17th of November 2013

The Society for Acute Medicine response to RCPE UK Medical Consensus on Urgent Care

The Society for Acute Medicine (SAM) welcomes the recommendations from the RCPE Consensus Conference which add to the weight of opinion calling for an effective consultant-led seven day service in the NHS. The report calls for a move to a 7-day NHS and the elimination of ‘boarding’ acutely ill patients.

Dr Alistair Douglas, SAM President said: “We are pleased to see a call for rebalancing the needs of emergency and elective patients as well as the recognition of the importance of maintaining sufficient capacity within acute medical units and medical wards at all times.

“Recognition that the whole system needs to change to provide the expected level of service and avoid the serious consequences of overcrowding in A&E and Acute Medical Units and also a commitment to eliminate boarding of medical patients (also known as outliers) which has been shown to be particularly associated with poorer outcomes is timely. We are also pleased to see the Society’s Clinical Quality Indicators recommended for adoption by all hospital trusts.”

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.
  • Dr Douglas is available for interview.

Contact:
Claire Charras
Communications and Marketing Executive
The Society for Acute Medicine
07 985 494 965
communications@acutemedicine.org.uk

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Seven Day Working for Consultants in the Acute Medical Unit

Introduction

This statement has been produced by the Society for Acute Medicine (SAM) to explain why we believe that consultant-led care must be consistently delivered in all acute medical units (AMUs) in the UK, 7 days per week.

Background

The speciality of Acute Medicine was developed over the past decade to ensure that patients receive high quality, consultant-led care when they are admitted to hospital with an acute illness.

Acute Illness is a seven day problem; patients are as likely to develop symptoms requiring hospital assessment or admission during a weekend or bank holiday as they are during a week day. Furthermore there is considerable UK and International evidence that patients admitted at weekends are more likely to die in hospital than those admitted during weekdays 1.2. This may, in part, reflect higher illness severity 3; however it is likely that organisational factors including the availability of senior medical staff, contribute to this problem 4.

Recommendation

  • SAM  recommends that all AMUs provide a consultant-led service seven days per week.
  • A consultant should be available on the AMU for 12 hours per day, including Saturday and Sunday.

Implementation

  • Implementation will require restructuring of existing rotas and consultant job plans.
  • Close collaboration between consultants specialising in acute medicine and general (internal) medicine (GIM) will be necessary to provide sustainable rota patterns.
  • SAM will provide example rotas to support hospitals in developing this.
  • At least 10 consultants will need to be participating in the weekend on-call rota for AMU
  • In many hospitals there will be a need for additional consultant appointments in acute medicine.

Conclusion

Patients deserve the same high quality consultant-led care irrespective of the day of the week on which they are admitted to hospital.  SAM is committed to supporting acute medical units in providing this through the development of new rotas involving existing and additional consultant staff.

References

1. Aylin P, Yunus A, Bottle A, Majeed A, Bell D. Weekend mortality for emergency admissions. A large, multicentre study. Qual Saf Health Care. 2010 Jun;19(3):213-7.

2. Clarke MS, Wills RA, Bowman RV, Zimmerman PV, Fong KM, Coory MD, et al. Exploratory study of the ‘weekend effect’ for acute medical admissions to public hospitals in Queensland, Australia. Intern Med J. 2010 Nov;40(11):777-83.

3. Mikulic O, Callaly E, Bennett K, O’Riordan D, Silke B. The increased mortality associated with a weekend emergency admission is due to increased illness severity and altered case-mix. Acute Medicine 10(4) 2011: 181-186

4. Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med. 2001 Aug 30;345(9):663-8.

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The Acute Medicine Speciality Certificate Examination (SCE)

The Acute Medicine SCE is an exam designed to test your knowledge of Acute Medicine. It is compulsory for all trainees on the Acute Medicine curriculum and optional for Acute Medicine trainees following other curricula. (Not sure what curriculum you are following? Click here.) Though some people may (incorrectly) refer to the SCE as an exit exam, you can take the exam at any stage of your training after being appointed to a substantive ST3 training post in Acute Medicine. Passing the SCE gives you the right to put MRCP (UK) (Acute Medicine) after your name. There are two papers, each consisting of 100 ‘best of five’ type questions. These may be on any subject contained within the Acute Medicine curriculum.

You are expected to display a level of knowledge equivalent to a consultant practising in Acute Medicine and this will include knowledge of relevant guidelines and scoring systems. Samples questions are available here and the MRCP website is the place to go for all the latest news about the exam, including dates, fees and how to apply. The first diet of the SCE was held on the 24th November 2010. Based SOLELY on the questions in that exam it would seem that the style and content of the questions is quite similar to MRCP Part II and that going back to your practice question books for those exams might be a good starting point.

There is, as one might expect, a skew towards more “acute” conditions that would present to the AMU and therefore we would advise focusing more on these rather than the chronic diseases which would more naturally present to a specialist outpatient clinic. In the first diet there was certainly more emphasis on poisoning and the signs and symptoms of illicit drug-use than would be expected in the average MRCP Part II paper. Another area worth focusing on would be common simple scoring systems (eg: CURB-65, ABCD2, Ranson score) so that you can calculate them and are aware of what mortality each score confers upon a patient. To further aid your revision you may also wish to refer to an excellent list of guidelines relevant to Acute Medicine compiled by Kate Akester, a Wessex Acute Medicine StR, which should help you keep up to date with the latest practice recommendations. At the current time there is only one exam sitting per year but this may increase in the future, if there is sufficient demand.

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In the news this week…24th of February till 2nd of March 2014

In the news this week…24th of February till 2nd of March 2014

Headlines…

NHS records ‘sold to insurers’. (HSJ, 24.02.2014)

Outgoing President’s, Dr Neil Dewhurst, Statement on the NHS. (RCPE, 25.02.2014)

Stafford Hospital: Health Secretary Hunt agrees to dissolve trust. (BBC, 26.02.2014)

Stethoscopes ‘more contaminated’ than doctors’ hands. (ITV, 27.02.2014)

Patients need to have control over their own information if care.data is to work. (Guardian Professional, 28.02.2014)

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“Acute medicine consultants are central to the delivery of seven-day consultant-led care.”

Strictly embargoed until Monday 18 November 00.01

SAM response to the AoMRC “Seven Day Consultant Present Care: Implementation Considerations” report: “Acute medicine consultants are central to the delivery of seven-day consultant-led care.”

The Society for Acute Medicine (SAM) welcomes today’s (Monday 18 Nov) publication of the Academy of Medical Royal Colleges’ (AoMRC) report which describes implementation considerations for a seven-day consultant present care.

The report recognises the challenges which will be faced by hospitals in implementing seven-day consultant present care, illustrating the amount of consultant time which will be required in the future and the types of investigations and support services needed.

The report also recognises that the delivery of seven-day consultant present care is likely to require additional consultant appointments as well as changes to the working practice of existing staff to ensure the development of sustainable working arrangements which encourage continuity of care. Additionally it highlights the key role which will be played by ‘generalists’, including acute physicians, in the future.

Dr Alistair Douglas, SAM President said: “We welcome this report which recognises that acute medicine consultants are central to the delivery of seven-day consultant-led care. Many acute medical units across the UK are already providing a 12-hour 7-day consultant presence, but it is important that daily consultant review continues when a patient moves to another part of the hospital.

“Access to appropriate investigations, interventions and support services is crucial to the delivery of high quality, safe and effective care for patients admitted to hospital in an emergency. Ensuring that these key services are available seven days per week will also shorten the length of time that many patients stay in hospital, easing congestion in the acute medical unit and A&E departments”.

Many acute medical units have pioneered the multi-disciplinary approach to patient care which is strongly supported by the document.

Dr Douglas added: “I am delighted that this report recognises the critical part which nurses, pharmacists, therapists and other allied healthcare professionals play in the delivery of acute hospital care; acute medical units have developed strong multidisciplinary teams which need to be sustained throughout the seven day week. The value of these teams should not be underestimated”.

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
The Society for Acute Medicine
07 985 494 965
communications@acutemedicine.org.uk

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Past Conferences

Past Conferences

The dates and venues of previous meetings are listed below. Where we have material such as lecture slides available for download we have created a link.

Conferences 2018:

SAMBournemouth, 20-21 September, Bournemouth International Centre

SAMsterDAM2, 3-4 May, Novotel City Hotel, Amsterdam

Conferences 2017:

SAMBirmingham, 11-12 September, ICC, Birmingham

SAMCardiff, 4-5 May, Mercure Holland House Hotel, Cardiff

Conferences 2016:

Past, Present, Future: Edinburgh International Conference of Medicine, 12-13 September 2016, Edinburgh International Conference Centre

SAMBelfast, 5-6 May, Titanic Belfast

Conferences 2015:

SAMManchester, 10-11 September, Manchester Central

SAMBristol, 7-8 May 2015, Bristol Marriott Hotel City Centre

Conferences 2014:

SAMsterDAM, 1-2 May 2014, Novotel Amsterdam

SAMBrighton, 2-3 October 2014, The Brighton Centre

Conferences 2007 – 2013:

Date City Venue
2013, Autumn Glasgow SECC Glasgow
2013, Spring Coventry Hilton Coventry
2012, Autumn Manchester Manchester Central Convention Complex
2012, Spring Dublin Radisson Blu Hotel
2011, Autumn London (International) Imperial College London
2011, Spring Bristol Marriott Hotel City Centre
2010, Autumn Edinburgh (International) Edinburgh International Conference Centre
2010, Spring Middlesborough Tall Trees Hotel
2009, Autumn Birmingham (International) National Exhibition Centre
2009, Spring Liverpool Adelphi Hotel
2008, Autumn London (International) Imperial College
2008, Spring Manchester Renaissance Hotel
2007, Autumn Glasgow (International) Scottish Exhibition and Conference Centre
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SAM response to NHS England Urgent and Emergency Care Review End of Phase 1 Report

For immediate release

13th of November 2013

The Society for Acute Medicine (SAM) response to NHS England Urgent and Emergency Care Review End of Phase 1 Report

NHS England published today the first of a series of reports reviewing urgent and emergency care.

Responding to the report, Dr Alistair Douglas, SAM President said: “We welcome the recommendations in this report particularly with regard to enhancements to prehospital care and an enhanced 111 service. Furthermore we strongly support the key proposal that we must help those with urgent care needs to get the right advice in the right place, first time as previously highlighted in the RCP Report of the Acute Medicine Task Force in 2007  .

However we are concerned that a key element of improving A&E services is the pathway for patients who do require admission to hospital. It is delays in accessing beds for these patients that is the major cause of A&E overcrowding and leads to breaches of the four hour target. This can only be improved by changing standard operating procedures within hospitals to ensure that receiving wards and in particular acute medical units (AMU) – which receive the greatest numbers of emergency admissions – have capacity at all times by improving bed management and patient flow and prioritising the needs of emergency patients.”

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.
  • Members of the Society for Acute Medicine were part of the Executive group for the RCP Report of the Acute Medicine Task Force 2007.
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Controlling Conflict of Interest Position Statement

The title of the Society shall be ’Society for Acute Medicine’ (SAM). Its object shall be to promote better care of patients who present with acute medical illness. In pursuing this object the Society shall:

  • Promote education of medical, nursing and paramedical staff in Acute Medicine.
  • Facilitate and co-ordinate the collection of data relevant to acute medical assessments and admissions.
  • Facilitate collaborative research in the area of Acute Medicine.
  • Promote the creation of appropriate environments for acute medical assessments and admissions.
  • Share good practice.
  • Promote the acute care models that exist as examples of improving the management of patients with acute medical problems
  • Provide encouragement to all members of the multi-disciplinary team that work in Acute Medicine.

SAM is the Society for Acute Medicine and as such plays an essential role in defining and advancing standards of acute medicine and developing the speciality of Acute Internal Medicine. Its conferences, practice guidelines, definitions of ethical norms, and public advocacy positions carry great weight with physicians and the public.

Conflict-of-interest policies of SAM should “protect the integrity of professional judgment” and “preserve public trust”. A conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.

As others have done, SAM seeks to balance the “important benefits” of physician-industry relations, such as research and education funding and the development of new types of investigations and treatments with the “significant risks that the financial goals of industry may conflict with the professional goals of medicine”.

GENERAL BUDGET SUPPORT

Institutional memberships grants are accepted by SAM for the purpose of supporting its mission and developing its objectives.

All funds from industry should be truly unrestricted. The donated funds should be pooled and administered through a central repository. SAM must have the freedom to set its own course and to modify both its goals and priorities, including the freedom to take positions on health-related issues that may be unfavourable to its funders. No single industry source should be responsible for the majority of total funding to SAM.

SAM CONFERENCES

Industry supports SAM meetings in a variety of ways, providing substantial funding.

A. Industry Sponsorship of Conference Programs. It is common practice for industry to fund conference programs. SAM should establish safeguards to limit industry influence. The SAM council has the responsibility to distribute unrestricted, educational grants from industry. This committee has exclusive authority to select program topics and speakers.

B. Conflict-of-Interest Standards for Conference Committee Members. Because of their ability to influence the content of educational programs, members of conference committees should adhere to SAM conflict-of-interest guidelines. The choice of topics and speakers is so essential to the integrity of the conference that independence of choice must be fully preserved and conflict-of-interest disclosures from officers and speakers at meetings should be made public.

C. Satellite symposia. Independent industry organized satellite symposia are allowed in SAM congresses. However, they are not the responsibility of SAM council and satellite symposia agendas have to be distinct from the official conference program.

INDUSTRY FUNDS FOR RESEARCH

To promote scientific progress, SAM should be able to accept grants for general support of research from pharmaceutical and device companies, provided that the grants are not designated for use by specific individuals. As long as SAM stands between the individual and the company making the grant, the likelihood of undue influence is minimized. To better ensure independence, scientific integrity, and full transparency, consulting agreements and unconditional grants should be posted on the publicly available SAM website. Research funds from industry, like educational support from industry, should go to an SAM central repository or committee as described above. The research awards should be peer reviewed without any involvement from industry.

TRAINING PROGRAMS

Industry may offer funding to SAM to support fellowships and training programs for SAM members. Providing these members with the opportunity to undertake intensive study, training, travel to educational meetings, and research is crucial for building a cohort of skilled healthcare professionals and researchers. But as in the case of funding for research, decision making about which members are chosen and the specific disciplines from which they are selected must be determined by the SAM alone.

SCIENTIFIC PUBLICATIONS

Given the importance of the findings and recommendations of SAM, both the creation and distribution of guidelines and other advisory materials should be independent of industry funding. No SAM scientific publication should bear the logo of a drug or device company. SAM scientific documents should always stand alone, should not be associated with a commercial brand, and ghost writing prohibited.

SAM PRESIDENT, COUNCIL MEMBERS AND OTHER OFFICERS

The reputation of SAM is based on the quality and integrity of its leaders. They speak for the society and are most visible to the public and the profession. SAM leaders also exert the greatest influence on policy, deciding which issues are to be addressed and the composition of the committees that will conduct the evaluations and issue the findings. Therefore, it is essential that the President, the council officer and members, and other officers be held to the highest standards in avoiding conflict of interest. SAM should have a formal mechanism for reviewing disclosures of conflict of interest.

This statement was extensively reviewed in the following two publications, listed below:

  1. Controlling Conflict of Interest — Proposals from the Institute of Medicine. New Engl J Med. 2009; 360:2160-2163.

Professional Medical Associations and Their Relationships With Industry. A Proposal for Controlling Conflict of Interest. JAMA. 2009;301:1367-1372.

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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

More