Blueprint for people who are acutely ill

The Royal College of Physicians today launches a blueprint to improve the quality and safety of care of people who are acutely ill.  At present most acute medicine is delivered by physicians who combine this work with other kinds of specialist care, but this is not ideal as very ill patients need the undivided attention of the teams caring for them.  ‘Acute Medicine:  making it work for patients’ suggests that the new specialty of acute medicine should form the axis around which clinical services  and facilities are developed.

Consultants in acute medicine are not the same as consultants in accident and emergency.  The former have expertise in the rapid assessment, diagnosis and treatment of patients who have a sudden illness which requires medical attention in hospital – such as breathlessness or chest pains.  The consultant in acute medicine manages the acute medicine service based in acute medical units, lead multidisciplinary teams and support colleagues in A&E departments, in high dependency units and on general wards.  They have a crucial role in the education and training of junior doctors and other consultant physicians.

The report focuses on the importance of consultants in acute medicine in ensuring that seriously ill people are correctly diagnosed and treated.  By increasing the numbers of such posts and focusing their daily activities on continuity of care of patients, this will improve standards of care.

RCP President Professor Carol Black on the significance of the report:

“I believe this to be one of the most important reports the College has produced in recent years.  The College has taken a lead role in addressing the question of how best to provide acute medical care in hospital and this report sets out the future direction for training, staffing and service organisation aimed at better delivering healthcare.  The report itself is only the beginning, we will need to embed the recommendations into the NHS to ensure real improvement.”

Recommendations in relation to direct patient care:

• There should be at least three consultants with primary responsibility for acute medicine in each acute hospital, and more in larger hospitals, by 2008
• That a doctor with appropriate skills in acute medicine, usually a specialist registrar, should be present at all times in all units receiving acute medical emergencies
• That an appropriately trained member of staff should assess according to clinical need, and certainly within four hours of arrival, all patients presenting to hospital as acute medical emergencies
• That 15 minutes for each new patient should be available on a consultant’s ‘post-take’ ward round
• That each new patient should be reviewed by a consultant physician within 24 hours, requiring the cancellation of other commitments by that physician – in most Trusts this will mean a consultant-led ward round at least twice in each 24-hour period
• That all trusts admitting acutely ill medical patients have a dedicated area where they can be managed, called an Acute Medical Unite (AMU), and all should develop emergency admissions policies

In relation to developing acute medicine as a specialty:

• That a network of advisers be established to take forward the development of acute medicine in England, including a physician in acute medicine in every Trust being given time to lead the development of the service; and regional specialty advisers to work with postgraduate Deans on issues such as training and funding
• That a National Director of Acute medicine be appointed by the Department of Health
• That dedicated time in the undergraduate curriculum is devoted to acute medicine, and formal teaching provided.  All medical students should have experience of acute medicine in an Acute Medical Unit
• That postgraduate training attachments should last for one to four months
• That the Postgraduate Medical and Education Training Board (PMETB) ensures that trainees in acute medicine receive dedicated experience in a wide variety of settings
• That clear pathways are developed to facilitate training in acute medicine for doctors in emergency and critical care who do not necessarily have the MRCP(UK) Diploma; and that PMETB should help doctors who want to retrain in acute medicine
• Flexible working and training should be encouraged

The RCP itself will also work towards supporting and expanding the specialty, and wants to develop the specialty in keeping with current Department of Health policies in this area.  The development of the specialty will fit the changes to junior doctors training as envisaged in Modernising Medical Careers.  Copies of the report will be sent to Trust Chief Executives and Medical Directors.

Dr Alistair Douglas, Chair of the Working Party and a Consultant in Renal Medicine, Glan Clwyd Hospital, said:

 “This report will of interest to all those working to provide emergency care to patients in hospital.  I hope it will be of practical benefit to doctors involved in the delivery of acute medicine.  It is an important step in ensuring the future care for patients with acute medical conditions.”

Professor Ian Gilmore, RCP Registrar, said:

 “For too long, patients with acute medical problems have had a raw deal when admitted to hospital and we must grasp the opportunity to provide a better patient experience, using this blueprint.”