Mark WL van Geffen, Koen M van der Waaij, Patricia M Stassen
BACKGROUND Internal medicine residents are frequently interrupted by phone calls, which may compromise workflow, work quality and job satisfaction. AIM This study investigates the number, nature and impact of calls on residents and their work during evening shifts in the emergency department and ward. METHODS This prospective observational study compares measurements from direct observations with subjective data from questionnaires. RESULTS Residents received 26 resp. 30 (median) calls per shift in the emergency department and ward, with duration of 50 resp. 80 seconds. Residents perceived high burden and impact on quality of work and job satisfaction. DISCUSSION & CONCLUSION Frequent interruptions by phone calls were observed, which resulted in high burden. Our study raises the urgency for finding solutions and provides insights necessary for possible interventions.
{"title":"Number, nature & impact of incoming telephone calls on residents and their work during evening shifts.","authors":"Mark WL van Geffen, Koen M van der Waaij, Patricia M Stassen","doi":"10.52964/AMJA.0886","DOIUrl":"https://doi.org/10.52964/AMJA.0886","url":null,"abstract":"BACKGROUND\u0000Internal medicine residents are frequently interrupted by phone calls, which may compromise workflow, work quality and job satisfaction.\u0000\u0000\u0000AIM\u0000This study investigates the number, nature and impact of calls on residents and their work during evening shifts in the emergency department and ward.\u0000\u0000\u0000METHODS\u0000This prospective observational study compares measurements from direct observations with subjective data from questionnaires.\u0000\u0000\u0000RESULTS\u0000Residents received 26 resp. 30 (median) calls per shift in the emergency department and ward, with duration of 50 resp. 80 seconds. Residents perceived high burden and impact on quality of work and job satisfaction.\u0000\u0000\u0000DISCUSSION & CONCLUSION\u0000Frequent interruptions by phone calls were observed, which resulted in high burden. Our study raises the urgency for finding solutions and provides insights necessary for possible interventions.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71185041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Anthonipillai, G. Sharp, J. Kimber, V. Ziauddin
We present the case of a 55 year old who presented multiple times with altered conscious levels. He was often treated as being post-ictal, when in fact, he had Sodium Valproate induced hyperammonaemic encephalopathy. Sodium Valproate can frequently increase ammonia levels, and in some patient lead to hyperammonaemic encephalopathy.
{"title":"Valproate-Associated Hyperammonaemic Encephalopathy.","authors":"P. Anthonipillai, G. Sharp, J. Kimber, V. Ziauddin","doi":"10.52964/AMJA.0891","DOIUrl":"https://doi.org/10.52964/AMJA.0891","url":null,"abstract":"We present the case of a 55 year old who presented multiple times with altered conscious levels. He was often treated as being post-ictal, when in fact, he had Sodium Valproate induced hyperammonaemic encephalopathy. Sodium Valproate can frequently increase ammonia levels, and in some patient lead to hyperammonaemic encephalopathy.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42917938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article describes my personal journey through Acute Medicine from the late 1980's and incorporates the development of Acute Medical Units (AMU's), co-establishing the Society for Acute Medicine (SAM), as well as involvement in the development of training curricula, research and audit. I am deeply indebted to a great number of professional colleagues over the last three decades, who have been pivotal to the development of the Acute Medicine specialism, and many of whom in turn became presidents of SAM.
{"title":"Guest Editorial - A personal journey in Acute Medicine.","authors":"D. Bell","doi":"10.52964/AMJA.0885","DOIUrl":"https://doi.org/10.52964/AMJA.0885","url":null,"abstract":"This article describes my personal journey through Acute Medicine from the late 1980's and incorporates the development of Acute Medical Units (AMU's), co-establishing the Society for Acute Medicine (SAM), as well as involvement in the development of training curricula, research and audit. I am deeply indebted to a great number of professional colleagues over the last three decades, who have been pivotal to the development of the Acute Medicine specialism, and many of whom in turn became presidents of SAM.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44617464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The screen time app on my iPhone tells me that I spend over ten hours a week on Twitter. And I'm not alone. As Netflix's The Social Dilemma illustrated, social media platforms are designed to keep us scrolling for hours, even if we only opened the app for a second. Thousands of UK healthcare workers use Twitter every day, discussing everything from cutting edge COVID treatments to staff room fridge etiquette. As strange as it sounds, this esoteric little corner of the internet - affectionately if unoriginally nicknamed "MedTwitter" - has become a thriving online community.
我iPhone上的屏幕时间应用程序告诉我，我每周花在Twitter上的时间超过10个小时。我并不孤单。正如Netflix的《社交困境》(The Social Dilemma)所展示的那样，社交媒体平台的设计目的是让我们持续滚动几个小时，即使我们只打开了一秒钟应用程序。成千上万的英国医护人员每天使用推特，讨论从最新的COVID治疗到员工室冰箱礼仪等各种问题。尽管这听起来很奇怪，但这个互联网的小角落——被亲切地称为“MedTwitter”——已经成为一个蓬勃发展的在线社区。
{"title":"What role should social media play in the future of acute medicine?","authors":"Z Ferguson","doi":"10.52964/AMJA.0910","DOIUrl":"https://doi.org/10.52964/AMJA.0910","url":null,"abstract":"<p><p>The screen time app on my iPhone tells me that I spend over ten hours a week on Twitter. And I'm not alone. As Netflix's The Social Dilemma illustrated, social media platforms are designed to keep us scrolling for hours, even if we only opened the app for a second. Thousands of UK healthcare workers use Twitter every day, discussing everything from cutting edge COVID treatments to staff room fridge etiquette. As strange as it sounds, this esoteric little corner of the internet - affectionately if unoriginally nicknamed \"MedTwitter\" - has become a thriving online community.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40705944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Dace, A. Srivastava, D. Milne, A. Howden, H. Kemp, N. Cantley
Gastric-bypass associated hyperammonaemia (GaBHA) is an under-recognised cause of non-hepatic encephalopathy that is associated with significant mortality and has limited reporting in published literature. GaBHA has been reported predominately in middle-aged females with a past surgical history of Roux-En-Y surgical procedure. Individuals may present at any stage post-surgery and an important minority may have an undiagnosed inherited metabolic disorder. We report a case of a 49 year old woman who presented acutely with encephalopathy, a significantly elevated plasma ammonia level, and substantial multifactorial nutritional deficiency which required correction with intensive enteral and parenteral nutritional support. This case represented a diagnostic and management challenge for acute medical physicians and the multidisciplinary team involved.
{"title":"Gastric bypass surgery contributing to hyperammonaemic encephalopathy: an under-reported cause of severe nutritional deficiency and significant patient mortality.","authors":"W. Dace, A. Srivastava, D. Milne, A. Howden, H. Kemp, N. Cantley","doi":"10.52964/AMJA.0890","DOIUrl":"https://doi.org/10.52964/AMJA.0890","url":null,"abstract":"Gastric-bypass associated hyperammonaemia (GaBHA) is an under-recognised cause of non-hepatic encephalopathy that is associated with significant mortality and has limited reporting in published literature. GaBHA has been reported predominately in middle-aged females with a past surgical history of Roux-En-Y surgical procedure. Individuals may present at any stage post-surgery and an important minority may have an undiagnosed inherited metabolic disorder. We report a case of a 49 year old woman who presented acutely with encephalopathy, a significantly elevated plasma ammonia level, and substantial multifactorial nutritional deficiency which required correction with intensive enteral and parenteral nutritional support. This case represented a diagnostic and management challenge for acute medical physicians and the multidisciplinary team involved.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44179040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The One Minute Preceptor (OMP) model of teaching has an important role to play during the COVID-19 pandemic. It's quick and easy to learn and can be applied to any clinical setting. By responding directly to a student's needs, and building on the knowledge they already hold, the OMP is able to offer relevant and opportunistic teaching that the learner can immediately apply. Finally, the OMP can be taught in under two hours meaning medical staff not used to regularly teaching can develop the confidence to offer high quality educational interventions.
{"title":"The One Minute Preceptor: A Vital Tool During COVID-19.","authors":"A. O'Connor, J. Abbas, H. McNeill","doi":"10.52964/AMJA.0897","DOIUrl":"https://doi.org/10.52964/AMJA.0897","url":null,"abstract":"The One Minute Preceptor (OMP) model of teaching has an important role to play during the COVID-19 pandemic. It's quick and easy to learn and can be applied to any clinical setting. By responding directly to a student's needs, and building on the knowledge they already hold, the OMP is able to offer relevant and opportunistic teaching that the learner can immediately apply. Finally, the OMP can be taught in under two hours meaning medical staff not used to regularly teaching can develop the confidence to offer high quality educational interventions.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46319980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Type 1 congenital methaemoglobinaemia is a rare cause of cyanosis which may manifest in affected individuals during concomitant illness. Treatment indications and aims differ from that of acquired methaemoglobinaemia. Type 1 methaemoglobinaemia is a distinct condition from the type 2 form which has a high mortality rate in infancy. A 25 year old male with known type 1 congential methaemoglobinaemia presented with cyanosis in the context of Influenza A with raised methaemoglobin levels on arterial blood gas analysis. The patient was assessed based on his level of 'functional haemoglobin' with no acute indication for IV methylene blue or ascorbic acid. Consideration could be given to prescription of these on a cosmetic basis for some patient populations.
{"title":"Case Report: Congenital Methaemoglobinaemia Type 1: Benign Cyanosis?","authors":"Judith R Fleming, Matthew I Maycock","doi":"10.52964/AMJA.0893","DOIUrl":"https://doi.org/10.52964/AMJA.0893","url":null,"abstract":"Type 1 congenital methaemoglobinaemia is a rare cause of cyanosis which may manifest in affected individuals during concomitant illness. Treatment indications and aims differ from that of acquired methaemoglobinaemia. Type 1 methaemoglobinaemia is a distinct condition from the type 2 form which has a high mortality rate in infancy. A 25 year old male with known type 1 congential methaemoglobinaemia presented with cyanosis in the context of Influenza A with raised methaemoglobin levels on arterial blood gas analysis. The patient was assessed based on his level of 'functional haemoglobin' with no acute indication for IV methylene blue or ascorbic acid. Consideration could be given to prescription of these on a cosmetic basis for some patient populations.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44525968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M Abou Chakra, M Peyromaure, N B Delongchamps, I Duquesne
Misplacement of a urinary catheter in the ureter is a rare phenomenon. The described cases occurred in patients with neurogenic bladder. We describe an unusual case of 58 years old female where the Foley catheter was unintentionally placed in the left ureter. The patient developed sepsis due to complete obstruction of the left ureter treated with antibiotic therapy after repositioning the catheter.
{"title":"Sepsis secondary to a misplaced urinary catheter into the ureter.","authors":"M Abou Chakra, M Peyromaure, N B Delongchamps, I Duquesne","doi":"10.52964/AMJA.0914","DOIUrl":"https://doi.org/10.52964/AMJA.0914","url":null,"abstract":"<p><p>Misplacement of a urinary catheter in the ureter is a rare phenomenon. The described cases occurred in patients with neurogenic bladder. We describe an unusual case of 58 years old female where the Foley catheter was unintentionally placed in the left ureter. The patient developed sepsis due to complete obstruction of the left ureter treated with antibiotic therapy after repositioning the catheter.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40705948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Atkin, T. Knight, T. Cooksley, M. Holland, C. Subbe, A. Kennedy, R. Varia, D. Lasserson
INTRODUCTION The Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21) took place on 17th June 2021, providing the first assessment of performance against the Society for Acute Medicine's Clinical Quality Indicators (CQIs) within acute medical units since the start of the COVID-19 pandemic. METHODS All acute hospitals in the UK were invited to participate. Data were collected on unit structure, and for patients admitted to acute medicine services over a 24-hour period, with follow-up at 7 days. RESULTS 158 units participated in SAMBA21, from 156 hospitals. 8973 patients were included. The number of admissions per unit had increased compared to SAMBA19 (Sign test p<0.005). An early warning score was recorded within 30 minutes of hospital arrival in 77.4% of patients. 87.4% of unplanned admissions were seen by a tier 1 clinician within 4 hours of arrival. Overall, the medical team performed the initial clinician assessment for 36.4% of unplanned medical admissions. More than a third of medical admissions had their initial assessment in Same Day Emergency Care (SDEC) in 25.4% of hospitals. 62.1% of unplanned admissions were seen by two other clinical decision makers prior to consultant review. Of those unplanned admissions requiring consultant review, 67.8% were seen within the target time. More than a third of unplanned admissions were discharged the same day in 41.8% of units. CONCLUSION Performance against the CQIs for acute medicine was maintained in comparison to previous rounds of SAMBA, despite increased admissions. There remains considerable variation in unit structure and performance within acute medical services.
{"title":"Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21): assessing national performance of acute medicine services.","authors":"C. Atkin, T. Knight, T. Cooksley, M. Holland, C. Subbe, A. Kennedy, R. Varia, D. Lasserson","doi":"10.52964/AMJA.0888","DOIUrl":"https://doi.org/10.52964/AMJA.0888","url":null,"abstract":"INTRODUCTION The Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21) took place on 17th June 2021, providing the first assessment of performance against the Society for Acute Medicine's Clinical Quality Indicators (CQIs) within acute medical units since the start of the COVID-19 pandemic. METHODS All acute hospitals in the UK were invited to participate. Data were collected on unit structure, and for patients admitted to acute medicine services over a 24-hour period, with follow-up at 7 days. RESULTS 158 units participated in SAMBA21, from 156 hospitals. 8973 patients were included. The number of admissions per unit had increased compared to SAMBA19 (Sign test p<0.005). An early warning score was recorded within 30 minutes of hospital arrival in 77.4% of patients. 87.4% of unplanned admissions were seen by a tier 1 clinician within 4 hours of arrival. Overall, the medical team performed the initial clinician assessment for 36.4% of unplanned medical admissions. More than a third of medical admissions had their initial assessment in Same Day Emergency Care (SDEC) in 25.4% of hospitals. 62.1% of unplanned admissions were seen by two other clinical decision makers prior to consultant review. Of those unplanned admissions requiring consultant review, 67.8% were seen within the target time. More than a third of unplanned admissions were discharged the same day in 41.8% of units. CONCLUSION Performance against the CQIs for acute medicine was maintained in comparison to previous rounds of SAMBA, despite increased admissions. There remains considerable variation in unit structure and performance within acute medical services.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71185420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The article by Subbe et al raise important considerations as to what is deemed quality care in medicine. Throughput in acute medicine is highly prized. Prompt decision making, and action, is certainly required for several groups of unwell patients, but there is system-wide pressure to maintain this fast pace for all patients. It does not automatically follow that quicker medicine benefits all patients to some degree. 'Productivity' may come at the cost of too much medicine - characterised by overdiagnosis, overtreatment, and substantial resource utilisation.
{"title":"Metrics are required for diagnostic accuracy in acute medicine.","authors":"M. Whyte, P. Kelly","doi":"10.52964/AMJA.0898","DOIUrl":"https://doi.org/10.52964/AMJA.0898","url":null,"abstract":"The article by Subbe et al raise important considerations as to what is deemed quality care in medicine. Throughput in acute medicine is highly prized. Prompt decision making, and action, is certainly required for several groups of unwell patients, but there is system-wide pressure to maintain this fast pace for all patients. It does not automatically follow that quicker medicine benefits all patients to some degree. 'Productivity' may come at the cost of too much medicine - characterised by overdiagnosis, overtreatment, and substantial resource utilisation.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71185438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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