25 February 2021
The immediate past president of the Society for Acute Medicine (SAM) has said there are “many questions to be answered” around the level of protection afforded to staff in acute medical units (AMUs) over the course of the pandemic.
Dr Nick Scriven said he was “sad and concerned” staff in the AMUs were still not seen as high enough risk to warrant full personal protective equipment (PPE) – despite a study showing staff were at the highest risk of infection.
He also said he was “not aware and had not seen” any of the government’s £450 million investment in urgent and emergency care for winter – announced in September – invested in AMUs to help manage pressures.
“Staff in acute medicine have played such a significant part in the management of Covid patients – as well as non-Covid emergency patients – throughout the pandemic but they have been overlooked far too often,” said Dr Scriven.
“There are many questions to be answered when it comes to investment in acute medical units across the NHS and the lack of full PPE despite evidence of staff in these areas being at higher risk of infection – double that of intensive care units.”
Dr Scriven spoke out following a wide-ranging survey of SAM members which covered funding, infection among staff, set-up of same day emergency care units (SDEC), support from employers, views on the vaccination programme and the government’s handling of the pandemic.
The survey found 33% of staff had been off work as a result of infection, which was reflective of data published last year in the journal Thorax which showed the highest risk of Covid-19 among cleaners (34.5%) and acute medical staff (33%), with the lowest risk among intensive care (15%) and emergency medicine (13%).
“Unlike respiratory and intensive care units which have been taken over almost entirely by Covid patients requiring aerosol generating procedures and so fall into higher level PPE guidelines, AMUs deal with a combination of Covid and non-Covid and, as a result, PPE recommendations are less stringent.
“Our staff have been central to the assessment of Covid patients at a point when it is crucial not to mix those with Covid, possibly with Covid and probably not with Covid prior to their test results being received, making it a high stakes assessment – and this is also while they have continued to manage non-Covid patients.
“Therefore it leaves me sad and concerned that at no point was it deemed necessary to elevate PPE recommendations to the higher level of protection – which is against World Health Organisation guidelines – and, although it is late in the day, I would still urge a re-risk assessment for AMUs.”
The survey also found 64% of members said no additional government funding had been given to AMUs, despite the specialty managing the immediate and early treatment of the majority of adult medical emergencies admitted from A&E.
While 14% said some funding had been given to SDEC units – facilities run by AMUs to alleviate pressures on emergency departments and bed capacity by providing urgent care without the need for overnight admission – only 29% had the ability to separate Covid and non-Covid patients.
Additionally, more than half (55%) said their SDEC units were hampered by the estate and facilities, 34% limited by staffing issues and 16% limited by diagnostic capability.
“Given the fact SDEC units can play such an important role in avoiding admissions over busy periods, particularly winter, it begs the question as to why only 14% of our members said additional funding reached their units especially as last year’s government investment was specifically meant to be for ensuring SDEC units as well as emergency departments were fit for purpose,” said Dr Scriven.
“Meanwhile, almost two-thirds said no additional funding came the way of their acute medical units to cope over such an intense winter period with Covid cases through the roof – this all points towards neglect of acute medicine at a time it was playing a crucial role in the management of Covid and non-Covid care.”
He also echoed previous concerns about staff welfare and warned the push to restart non-urgent services would push the needs of acute services “down the list” and “far from ideal for patient safety and wellbeing”.
“While our teams will be forever grateful for the daily help they had from local staff plugging gaps left by highly-trained acute medicine professionals being redeployed to intensive care units and respiratory support units, we are fearful that the restarting of non-acute services will further push our needs down the list.
“This will leave units running with exhausted staff who have been stretched to the max and these circumstances will be far from ideal for staff or patient safety and wellbeing.”