scholarly journals Response to winter pressures in acute services: analysis from the Winter Society for Acute Medicine Benchmarking Audit

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Catherine Atkin ◽  
Thomas Knight ◽  
Chris Subbe ◽  
Mark Holland ◽  
Tim Cooksley ◽  
...  
Keyword(s):  
Acute Hospital ◽  
Hospital Services ◽  
Acute Medicine ◽  
Medicine Department ◽  
Delivery Of Care ◽  
The United Kingdom ◽  
National Guidance ◽  
Acute Hospitals ◽  
Emergency Medicine Department ◽  
Increased Pressure

Abstract Background There is increased demand for urgent and acute services during the winter months, placing pressure on acute medicine services caring for emergency medical admissions. Hospital services adopt measures aiming to compensate for the effects of this increased pressure. This study aimed to describe the measures adopted by acute medicine services to address service pressures during winter. Methods A survey of acute hospitals was conducted during the Society for Acute Medicine Benchmarking Audit, a national day-of-care audit, on 30th January 2020. Survey questions were derived from national guidance. Acute medicine services at 93 hospitals in the United Kingdom completed the survey, evaluating service measures implemented to mitigate increased demand, as well as markers of increased pressure on services. Results All acute internal medicine services had undertaken measures to prepare for increased demand, however there was marked variation in the combination of measures adopted. 81.7% of hospitals had expanded the number of medical inpatient beds available. 80.4% had added extra clinical staff. The specialty of the physicians assigned to provide care for extra inpatient beds varied. A quarter of units had reduced beds available for providing Same Day Emergency Care on the day of the survey. Patients had been waiting in corridors within the emergency medicine department in 56.3% of units. Conclusion Winter pressure places considerable demand on acute services, and impacts the delivery of care. Although increased pressure on acute hospital services during winter is widely recognised, there is considerable variation in the approach to planning for these periods of increased demand.

scholarly journals Acute hospital medical staffing during the night shift

1998 ◽  
Vol 21 (4) ◽  
pp. 163 ◽  
Author(s):  
Ken Hillman ◽  
Sean Beehan
Keyword(s):  
Night Shift ◽  
Acute Hospital ◽  
Junior Doctors ◽  
Great Cost ◽  
Acute Medicine ◽  
Acute Hospitals ◽  
High Level ◽  
General Wards ◽  
Cost Implications

There has been little or no attempt to define the need for 24-hour medical cover, norits appropriateness in acute hospitals, despite the great cost implications and thequestion of the quality of that care. This study examined the medical activity duringthe ?night shift? in an acute hospital. There were an average of 2.59 calls per night,most from the emergency department (247/475) and general wards (108/475). Manycalls were related to active resuscitation (88/475) and immediate treatment (83/475).Over 40% (81/286) of patients had to be transferred to a higher level of care, suchas an intensive care unit within the hospital. By collecting data on the demands ofhealth care during what amounts to over a third of the hospital?s time, it wasestablished that a high level of medical care was required. Appropriate levels ofstaffing, using junior doctors trained in acute medicine, was able to be provided tomatch need as determined by these data, and extra staff at higher costs were avoided.

Denial of Health Care and Informed Consent in English and American Law

1992 ◽  
Vol 18 (1-2) ◽  
pp. 37-71
Author(s):  
Frances H. Miller
Keyword(s):  
United States ◽  
Health Care ◽  
Informed Consent ◽  
The United States ◽  
Health Care Rationing ◽  
Legal Obligation ◽  
The United Kingdom ◽  
American Law ◽  
Care Rationing ◽  
Increased Pressure

Health care rationing has gained greater visibility in the United States and the United Kingdom, for quite different reasons. As patients in both countries become more aware that potentially beneficial medical services can be denied them on economic — as opposed to purely medical — grounds, they are beginning to seek help from the judiciary. This Article contends that as rationing becomes more explicit, the doctrine of informed consent will come under increased pressure. The Article suggests that courts and legislatures consider imposing a legal obligation on physicians to inform their patients when potentially effective treatment is to be withheld for economic or other non-clinical reasons.

THE WAY AHEAD FOR ACUTE HOSPITAL SERVICES

The Lancet ◽  
1976 ◽  
Vol 308 (7997) ◽  
pp. 1235-1237 ◽  
Author(s):  
Bryan Jennett
Keyword(s):  
Acute Hospital ◽  
Hospital Services ◽  
The Way

scholarly journals Analysis of drug related electrolyte disturbances in emergency medicine department

2018 ◽  
Vol 7 (10) ◽  
pp. 2005
Author(s):  
Karan B. Shah ◽  
Sapna D. Gupta ◽  
Devang A. Rana ◽  
Supriya D. Malhotra ◽  
Pankaj R. Patel
Keyword(s):  
Emergency Medicine ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
The Body ◽  
Electrolyte Balance ◽  
Medicine Department ◽  
Electrolyte Disturbance ◽  
Exact Test ◽  
Electrolyte Disturbances ◽  
Emergency Medicine Department

Background: Electrolytes play an important role in various physiological functions of the body. Electrolyte disturbances are one of the most common problems encountered in critically ill patients. Drugs are also known to cause adverse electrolyte consequences. These drugs could be anti-hypertensive agents, hormones, antipsychotics or steroids. There is paucity of published literature on electrolyte disturbances caused by drugs. The purpose of our study was to evaluate the electrolyte disturbances caused by various drugs in critically ill patients.Methods: Following approval of the Institutional Ethics Committee, data collection was started. Adverse Drug Reactions (ADRs) presenting as an electrolyte disturbance in emergency medicine department or occurring in hospitalized patients in the Intensive care unit (ICU) of our hospital was be collected. ADRs resulting into electrolyte disturbances were identified and analysed in detail for demographic details, types of electrolyte disturbances, seriousness, severity, causality and preventability of ADRs. Fisher's exact test was done to find out the statistical difference between the electrolyte disturbances and different drugs.Results: Total 58 ADRs were reported as an electrolyte disturbance. Mean age of the patients affected was 52.48 years. Highest number of ADRs were observed in the age group of 61 to 70 years. Hypokalemia constituted 32 cases (55.2%) followed by hyponatremia (25.9%), hyperkalemia (6.9%), hypernatremia (6.9%), hypocalcemia (1.7%), hypomagnesemia (1.7%) and hypophosphatemia (1.7%). Insulin was associated with maximum cases of ADRs (27.6%).Conclusions: Electrolyte disturbances constitutes a major chunk of ADRs especially in critically ill patients. The physicians must be well-versed with the dynamics of fluid-electrolyte balance.

scholarly journals The ‘weekend effect’ in acute medicine: a protocol for a team-based ethnography of weekend care for medical patients in acute hospital settings

BMJ Open ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. e016755 ◽  
Author(s):  
Carolyn Tarrant ◽  
Elizabeth Sutton ◽  
Emma Angell ◽  
Cassie P Aldridge ◽  
Amunpreet Boyal ◽  
...  
Keyword(s):  
Acute Hospital ◽  
Weekend Effect ◽  
Medical Patients ◽  
Acute Medicine

Acute hospital services in London

BMJ ◽  
1981 ◽  
Vol 282 (6268) ◽  
pp. 996-997
Author(s):  
K A M Grant
Keyword(s):  
Acute Hospital ◽  
Hospital Services

Factors Associated with Timely Surgery for Semi-elective Distal Radius Fracture Fixation

2021 ◽  
Author(s):  
Nick A. Johnson ◽  
Joseph J. Dias
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Trauma Surgery ◽  
Radius Fracture ◽  
National Guidelines ◽  
The United Kingdom ◽  
Articular Fractures ◽  
Seasonal Factors ◽  
National Guidance ◽  
The Relationship

Abstract Background In the United Kingdom, national guidance recommends intra-articular distal radius fractures should undergo surgery within 72 hours and extra-articular fractures within 7 days. Purpose We investigated if hospitals can provide timely surgery and meet national guidelines in patients who are sent home following distal radius fracture (DRF) to return for planned surgery. The influence of patient, hospital, and seasonal factors on wait to surgery are investigated. Patients and Methods We reviewed Hospital Episode Statistics (HES) data between April 2009 and March 2013. Proportion of procedures being performed within 3 and 7 days was calculated. A linear regression model was created to investigate the relationship between wait for surgery and patient and hospital factors. Results A total of 9,318 patients were sent home to return for planned acute DRF surgery during the 4-year study period. Mean time to surgery was 3.04 days (range 1–days, standard deviation [SD] 3.14). A total of 6,538 patients underwent surgery within 3 days (70.2%) and 8,747 within 7 days (93.9%). Patients listed for surgery and sent home to return waited longer if listed toward the end of the week. Less surgery was performed at weekends, and patients were less likely to be listed for semielective trauma surgery. Conclusions Acute semielective DRF fixation is generally performed within targets for extra-articular fractures but there is scope for improvement for intra-articular fractures. Day of presentation and increasing number of comorbidities increase wait for surgery. Hospital trusts should focus on improving pathways for patients with multiple comorbidities and strategies to improve accessibility of these services at weekends.

scholarly journals Behavioural and psychiatric symptoms in people with dementia admitted to the acute hospital: prospective cohort study

2014 ◽  
Vol 205 (3) ◽  
pp. 189-196 ◽  
Author(s):  
Elizabeth L. Sampson ◽  
Nicola White ◽  
Baptiste Leurent ◽  
Sharon Scott ◽  
Kathryn Lord ◽  
...  
Keyword(s):  
Cohort Study ◽  
Older People ◽  
Psychiatric Symptoms ◽  
Hospital Staff ◽  
Care Quality ◽  
Acute Hospital ◽  
Medical Illness ◽  
People With Dementia ◽  
Hospital Patients ◽  
Acute Hospitals

BackgroundDementia is common in older people admitted to acute hospitals. There are concerns about the quality of care they receive. Behavioural and psychiatric symptoms of dementia (BPSD) seem to be particularly challenging for hospital staff.AimsTo define the prevalence of BPSD and explore their clinical associations.MethodLongitudinal cohort study of 230 people with dementia, aged over 70, admitted to hospital for acute medical illness, and assessed for BPSD at admission and every 4 (±1) days until discharge. Other measures included length of stay, care quality indicators, adverse events and mortality.ResultsParticipants were very impaired; 46% at Functional Assessment Staging Scale (FAST) stage 6d or above (doubly incontinent), 75% had BPSD, and 43% had some BPSD that were moderately/severely troubling to staff. Most common were aggression (57%), activity disturbance (44%), sleep disturbance (42%) and anxiety (35%).ConclusionsWe found that BPSD are very common in older people admitted to an acute hospital. Patients and staff would benefit from more specialist psychiatric support.

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