As those working in Acute Medicine gather at SAMsterDAM2, the spring conference of the Society for Acute Medicine, the growth, reputation and global representation of the specialty continues to grow. Alongside, the traditional strongholds of the UK, Ireland, Netherlands, Denmark and Australia growth in Asia continues with an AMU now established in Pakistan among other countries. The global growth and interest in Acute Medicine is reflected in this issue of the journal, in which we are delighted to have a truly international cohort of authors. The papers in this issue add to the understanding of some of the fundamental tenets of the specialty key to delivering high quality acute medical care, including international adaptation of the AMU model of care, the Acute Medicine/Primary Care interface, the referral of older patients to Critical Care, readmissions and a reminder of the opportunities an acute medical admission presents to perform important health screening interventions. Rombach et al. describe the impact of implementing an AMU model of care in Amsterdam. The results of the first four years of the model mirror those seen following their introduction in the UK with improved patient flow and reduced length of stay with no effect on readmission rates. The crucial topic of trying to ensure and describe optimal transfer of clinical information between the Acute Medicine and Primary Care interface is addressed through a quality improvement project by Lockman et al. with an accompanying editorial by Professor Dan Lasserson. Their success highlights the opportunities to drive quality through multi-specialty working and innovative thinking. Nannan-Panday et al. examine the vital sign changes in readmitted patients. They describe that deterioration in key physiological signs is common in patients with unplanned readmissions and suggest early intervention through wearable technologies may be a strategy for reducing this adverse event. Bosch et al. retrospectively analyse the outcomes of elderly patients admitted to Intensive Care directly from the Emergency Department compared to those admitted from general wards finding the former group have better outcomes. This reinforces the importance of early decision making, particularly in elderly patients, so fundamental to the practice of Acute Medicine. Rice et al. report the results of a quality improvement project focusing on HIV testing in their Emergency Department at the world’s largest cancer hospital. They reflect that acute care specialties are uniquely positioned to influence clinical practice because of the large cross section of patients for whom it supports. As we as Acute Medicine practitioners reflect on what we are achieving and what there is to accomplish, we need to remind ourselves that the global footstep of our specialty is increasing and we have the opportunity to imprint its principles further in the acute care of medical patients.
Applying the Diabetes Quality Improvement Project Indicators in the Indian Health Service Primary Care Setting
