Acute Medicine最新文献

The NHS and social care services remain under immense pressure. Each part of the system continues to experience demand beyond its capacity which exacerbates the problem. This is most vividly illustrated in urgent and emergency care. Once again, this winter, media is full of pictures of patients in corridors; long queues of ambulances outside of emergency departments and stories of horrific patient experiences: reflecting the appalling situation witnessed and practiced by acute medical teams daily.

Background: The COVID-19 pandemic has strained the healthcare system with emergency department (ED) boarding and workforce shortages. This prompted the need for strategies to evaluate and treat patients while they waited for an ED room.

Objectives: The objective is to describe a waiting room evaluation process and ED throughput in the setting of ED staffing shortages and boarding.

Methods: This is a retrospective before and after cohort study evaluating ED throughput before and after initiation of the assessed waiting room (aWR) process. The aWR process is a joint effort by emergency clinicians and ancillary staff to evaluate and treat patients in the ED waiting room when no ED bed is available. Throughput data 6 months before and 6 months after institution of aWR was collected and analyzed.

Results: The arrival to provider time and the number of patients who left without being seen (LWBS) decreased with initiation of the aWR process. The remainder of throughput metrics remained unchanged. There was more ED boarding at Wisconsin sites during the aWR process period.

Conclusions: The aWR process may minimize LWBS and improve arrival to provider time in the setting of staff shortages and more ED boarders. It may help other ED throughput metrics although numerous confounding factors make it difficult to make definitive conclusions. This process may be trialed during times of challenging healthcare landscape, such as pandemic conditions and with workforce shortages.

Performance within acute medicine services is impacted by ongoing pressures on acute care services. Data from the Society for Acute Medicine Benchmarking Audit 2023 (SAMBA23), was used to assess performance of acute medicine services compared to key clinical quality indicators, comparing performance by initial assessment location. Data was analysed for 8213 unplanned attendances across 161 hospitals. Comparing by initial assessment location, performance against the clinical quality indicators was unchanged from 2022. Only 29% of daytime arrivals assessed within the Emergency Department received consultant review within target times. Delays were seen in transfer between acute care locations. 29% of patients requiring admission were not admitted to the AMU. There is ongoing variation in acute medical service performance nationally, with significant delays in patient access to appropriate assessment locations.

This is a case report of a patient who presented with neck pain and intermittent pyrexia as a manifestation of pseudogout of the neck.

Background: the optimal period over which respiratory rate should be measured is uncertain.

Setting: medical ward of low resource Ugandan hospital, Methods: comparison of the first respiratory rates measured on admission over seconds using a smartphone application with measurements over 15 minutes using a piezoelectric device.

Results: There was a poor correlation between respiratory rates measured by the piezoelectric device and rates measured by a smartphone application. Although the discrimination for mortality of piezoelectric respiratory rates were slightly higher than those derived from the application, there were not statistically significant differences.

Conclusion: this study could not demonstrate potential clinical benefits that justify measuring the first respiratory rate after admission over 15 minutes by a device.

Introduction: Cardiovascular diseases are a substantial burden on healthcare systems, contributing significantly to avoidable hospital admissions. We propose a Cardiology Ambulatory Care Pathway.

Methods: Conducted a 1 month study redirecting admission streams from primary and emergency care, into a Cardiology Ambulatory Care Hub providing triage in Hot Clinic, and access to a Multi-Modal Testing Platform.

Results: 98 patients were referred to the Ambulatory Care Hub, 91 of which avoided admission. 52 patients received care in the cardiology hub, 38 of which required further testing.

Conclusion: We successfully streamlined various service streams, reducing admissions, and improving patient outcomes. Outpatient CTCA, ambulatory ECG, and echocardiography proved instrumental. We project a cost saving of £53,379 per month in bed days (£640,556 annual saving).

The training of Acute Physicians is crucial for future delivery of high-quality urgent care. The 2024 Acute Medicine Trainee Survey gathered 124 responses, assessing training satisfaction, challenges, and progress since the 2022 curriculum update. Most trainees (66.2%) reported satisfaction, with access to training in Point-of-Care Ultrasound (POCUS) improving (74.7% vs. 63% in 2023). Disparities in training provision and burnout remain significant concerns, with 29.1% experiencing burnout and 40% feeling at risk of this. Key challenges included patient flow issues, rota gaps, and limited respect from colleagues. Despite this, trainee satisfaction is rising, with the majority (88.7%) recommending a career in Acute Medicine. Continued efforts are essential to ensure equitable access to training opportunities and supporting well-being in this demanding specialty.

This article presents the case of a 25-year-old Moroccan male who contracted Orf disease (Ecthyma contagiosum), a common zoonotic viral infection in sheep and goats. The disease, caused by a parapoxvirus, can be transmitted to humans through contact with infected animals. The patient developed painful lesions on his fingers after interacting with a sheep during the Feast of Sacrifice. Diagnosis was clinically established considering exposure history and lesion characteristics. Treatment involved local antiseptics and 2% fusidic acid cream. The lesions resolved spontaneously over a few weeks without functional impairment.

Recently I had to have a few minutes in my office to regroup after I'd seen a patient. I didn't quite know how to process my feelings. I was feeling ashamed and upset. My patient had been in our waiting room for over 18 hours. He was a bilateral amputee and a wheelchair user. His medical problem was not life threatening and easy to treat but was affecting his arm and so affected his ability to care for himself, hence the need for admission. He was usually normally independent, worked full time, headed up a local charity but now suddenly found himself incredibly vulnerable.

The advent of the SARS-CoV-2 pandemic brought unprecedented challenges to healthcare systems worldwide. As the virus spread across continents, hospitals faced a surge in patient admissions, particularly to intensive care units (ICUs). Understanding the impact of the pandemic on the sickest patients admitted to hospital is crucial for enhancing preparedness for future outbreaks. In this edition of the journal, authors from Denmark report on a register-based national observational study that sheds light on the changes in ICU admission rates and demographic profiles of patients during the initial phase of the pandemic.