scholarly journals Case based review: Toxicology on the Acute Medical Unit

2019 ◽  
Vol 18 (1) ◽  
pp. 23-32
Author(s):  
A Achilleos ◽  
◽  
Oliver Collas ◽  
Nicholas Murch ◽  
◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Clinical Course ◽  
Signs And Symptoms ◽  
Organic Substances ◽  
Front Line ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Clinical Vignettes ◽  
The Uk ◽  
Case Based

Accidental and intentional poisoning from prescribed, illicit and organic substances remains a major cause of morbidity and mortality worldwide and accounts for just under 1% of the total number of NHS hospital admissions, or around 170,000, a year in the UK. A knowledge of the constellation of signs and symptoms that constitute specific poisonings (referred to as toxidromes) may enable early empirical decontamination, antidote administration, enhanced elimination and supportive care, and may also help to predict the clinical course. This paper presents a series of clinical vignettes to demonstrate emerging presentations in toxicology to help inform the practice of Acute Physicians, who alongside colleagues in Emergency Medicine and Critical Care, are at the front line of diagnosing and treating poisoned patients.

scholarly journals Rhythmicity of patient flow in an acute medical unit: relationship to hospital occupancy, seven-day working, and the effect of COVID-19

QJM ◽  
2021 ◽  
Author(s):  
S J Dauncey ◽  
P A Kelly ◽  
D Baykov ◽  
A C Skeldon ◽  
M B Whyte
Keyword(s):  
Hospital Admissions ◽  
Fourier Transforms ◽  
Patient Flow ◽  
Cohort Analysis ◽  
Information Management System ◽  
Hospital Performance ◽  
Bed Occupancy ◽  
Urban Hospital ◽  
Medical Unit ◽  
Acute Medical Unit

Abstract Background The Acute Medical Unit (AMU) provides care for unscheduled hospital admissions. Seven-day Consultant presence and morning AMU discharges have been advocated to improve hospital bed management. Aims To determine whether a later time of daily peak AMU occupancy correlates with measures of hospital stress; whether seven-day Consultant presence, for COVID-19, abolished weekly periodicity of discharges. Design Retrospective cohort analysis Methods Anonymised AMU admission and discharge times were retrieved from the Profile Information Management System (PIMS), at a large, urban hospital from 14th April 2014—31st December 2018 and 20th March—2nd May 2020 (COVID-19 peak). Minute-by-minute admission and discharge times were combined to construct a running total of AMU bed occupancy. Fourier transforms were used to determine periodicity. We tested association between i) average AMU occupancy and ii) time of peak AMU occupancy, with measures of hospital stress (total medical bed occupancy and ‘medical outliers’ on non-medical wards). Results Daily, weekly and seasonal patterns of AMU bed occupancy were evident. Timing of AMU peak occupancy was unrelated to each measure of hospital stress: total medical inpatients (Spearman’s rho, rs=0.04, P = 0.24); number of medical outliers (rs=-0.06, P = 0.05). During COVID-19, daily bed occupancy was similar, with continuation of greater Friday and Monday discharges than the weekend. Conclusions Timing of peak AMU occupancy did not alter with hospital stress. Efforts to increase morning AMU discharges are likely to have little effect on hospital performance. Seven-day Consultant presence did not abolish weekly periodicity of discharges – other factors influence weekend discharges.

How do junior doctors spend their time in an Acute Medical Unit?

2015 ◽  
Vol 14 (2) ◽  
pp. 57-60
Author(s):  
Eirini V Kasfiki ◽  
◽  
Mamoon Yusaf ◽  
Jivendra Gosai ◽  
Makani Purva ◽  
...  
Keyword(s):  
General Practice ◽  
Hospital Admission ◽  
Postgraduate Training ◽  
Junior Doctors ◽  
Bed Occupancy ◽  
Medical Unit ◽  
Admission Rates ◽  
The Past ◽  
Acute Medical Unit ◽  
The Uk

In the UK, postgraduate training for doctors has undergone significant changes over the past decade general practice, etc. During this period, hospital admission rates and bed occupancy have also increased.

scholarly journals Trainee Update September 2014

2014 ◽  
Vol 13 (3) ◽  
pp. 131-131
Author(s):  
Nerys Conway
Keyword(s):  
Internal Medicine ◽  
Chief Executive ◽  
Important Work ◽  
Acute Medicine ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
The Family ◽  
The Uk ◽  
Southmead Hospital ◽  
New Jobs

I hope you have all settled well into your new jobs and a very warm welcome to those that have recently joined the ‘family’ of acute medicine. I would first of all like to thank Ruth Johnson for all her hard work as trainee representative over the last 18 months and wish her all the best as she ventures into consultant territory: her replacement will be announced later in the autumn. July was a busy month, dominated by our Acute Medicine Awareness Week, during which AMUs across the UK undertook events to raise the profile of the speciality and the important work they were doing locally. Barnsley completed a 25 mile virtual marathon, Crosshouse Hospital made £350 in a cake sale, Salford Royal staff walked around every acute medical unit in Greater Manchester, North Staffordshire staff ran a half marathon and there was more cake on sale in Kings College and Leicester Royal. The AMU staff at Southampton raised over £400 with their cake sale and cycle challenge, during which they were joined by the Trust Chief Executive for a ‘virtual’ 120 miles on an exercise bike situated outside the hospital entrance. The highlight, however was the contribution of Dr Nigel Lane, an acute medicine trainee from Southmead Hospital in North Bristol, who put together an outstanding weekly programme of events. This included a visit from the Chief Executive of the trust, visit from local GPs to the unit, daily MDT teaching, daily ‘messages of the day’ located on the trust website and lots of screensavers, banners and information scattered throughout the hospital. I am delighted to announce that Nigel has received the SAM awareness week prize. This involves the opportunity to join the European School of Internal Medicine and attend the winter EFIM school camp in Latvia. Nigel will also be joining us as one of the speakers in the trainee session at SAM Brighton. He will be speaking on “Preparing for your PYA”. There will also be talks in the trainee session on “Keeping your e-portfolio updated”, “Choosing your specialist skill” and “Preparing for your consultant job”. The session will be aimed at both junior and senior trainees. The trainee that has produced the best poster at Brighton will also have a chance to win a place to attend the summer EFIM school camp. The day before the conference starts there will be a SCE revision session. I attended last year and found it extremely helpful! Looking forward to seeing you all in Brighton. In the meantime if you have any problems or suggestions please tweet or email me at the addresses below.

scholarly journals Ovarian Hyperstimulation Syndrome on the Acute Medical Unit: A problem-based review

2015 ◽  
Vol 14 (1) ◽  
pp. 21-27
Author(s):  
Rebeca Carter ◽  
◽  
Kyle Petrie ◽  
Ashkan Sadighi ◽  
Hannah Skene ◽  
...  
Keyword(s):  
Ovarian Hyperstimulation Syndrome ◽  
Signs And Symptoms ◽  
In Vitro Fertilisation ◽  
Ovarian Hyperstimulation ◽  
Care Services ◽  
Acute Medical Unit ◽  
Life Threatening ◽  
Acute Care Services ◽  
The Uk

Ovarian Hyperstimulation Syndrome (OHSS) is a spectrum of clinical features typically resulting from assisted conception techniques. With 2.35% of all live births in the UK resulting from in-vitro fertilisation (IVF), OHSS is on the rise. Moreover, there has been an increase in the presentation of its complications to GP surgeries and unscheduled acute care services nationwide. This review will discuss signs and symptoms of the increasingly common and potentially fatal complications of OHSS, namely pleural effusion, ascites and thromboembolic events. With such propensity toward critical, life-threatening events it is not only prudent to recognise the population at risk, but also to be aware of the signs, symptoms and complications to expedite treatment and ensure optimum outcome.

An overview of lower limb cellulitis in an acute medical ward-a few lessons we can learn

2019 ◽  
Vol 18 (1) ◽  
pp. 4-9
Author(s):  
Si Hua Mabel Tan ◽  
◽  
Tian En Jason Tay ◽  
Pek Siang Edmund Teo ◽  
Stephanie Fook-Chong ◽  
...  
Keyword(s):  
Lower Limb ◽  
Readmission Rate ◽  
Hospital Admissions ◽  
Duration Of Treatment ◽  
Common Cause ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Previous Stroke ◽  
Patients With Diabetes ◽  
The Mean

Lower limb cellulitis is a common cause for hospital admissions. In this retrospective study, we assessed the characteristics and outcome of patients admitted in an acute medical unit. The mean duration of treatment was 10.48 days, with 95.5% receiving antibiotics for more than 5 days. Mean length of stay (LOS) was 5.19 days. 12-month readmission rate was higher in patients with diabetes, chronic kidney disease (CKD) and previous stroke. Diabetes, CKD, previous stroke, and elevated procalcitonin levels were independently associated with prolonged admission (>3 days).

An Accident and Emergency Department's View of Self-poisoning: a Retrospective Study from the United Norwich Hospitals 1978-1982

1986 ◽  
Vol 5 (1) ◽  
pp. 5-10 ◽  
Author(s):  
R.H.M. Adams
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Hospital Admissions ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Accident And Emergency ◽  
Accident And Emergency Department

This 5-year review of deliberate self-poisoning cases seen in an accident and emergency department revealed that about 700 patients were seen per year. Three-quarters of these needed admission (forming some 15% of all hospital admissions). Of these 65% were referred to the psychiatrist. The remaining quarter were dealt with in the accident and emergency department. Analysis of the data identifies problems where further research is needed. In particular the question is raised as to whether these patients would not be better dealt with in an acute medical unit now that accident departments are turning their attention increasingly to the management of trauma.

scholarly journals When is a stroke not a stroke? An unusual mimic presenting to AMU

2016 ◽  
Vol 15 (1) ◽  
pp. 33-36
Author(s):  
Shyamal Patel ◽  
◽  
Nicholas Smallwood ◽  
Hyacinth-John Abu ◽  
Youssif Abousleiman ◽  
...  
Keyword(s):  
Prion Disease ◽  
Signs And Symptoms ◽  
Progressive Dementia ◽  
Medical Unit ◽  
Early Palliative Care ◽  
Acute Medical Unit ◽  
Abnormal Movements ◽  
Jakob Disease ◽  
Eeg Changes ◽  
Mri Changes

Introduction: Creutzfeldt-Jakob disease (CJD) is a rare prion disease classically manifesting with rapidly progressive dementia, abnormal movements and typical electroencephalographic (EEG) changes. Case Report: A 74 year-old Caucasian man was recently discharged from another centre diagnosed with a stroke. He re-presented to our acute medical unit with worsening symptoms, and stroke remained the working diagnosis. Collateral history revealed a progressive cognitive decline and unilateral myoclonus. Further investigations supported the diagnosis of probable CJD, confirmed by the national CJD surveillance centre. Discussion: Signs and symptoms atypical of stroke should raise the possibility of alternative diagnoses, including prion disease. CJD can present with unilateral symptoms, EEG and MRI changes. Early diagnosis prevents unnecessary investigations and treatments, allowing early palliative care input, where appropriate.

scholarly journals Acute medical unit clinical skills lab

2019 ◽  
Vol 6 (Suppl 1) ◽  
pp. 140-140
Author(s):  
Sarb Clare ◽  
Joe Wheeler
Keyword(s):  
Clinical Skills ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Skills Lab

scholarly journals Causes of discharge delays from the acute medical unit (AMU) in a tertiary level teaching hospital, Brunei Darussalam

2021 ◽  
pp. 201010582110061
Author(s):  
Dayang Nur Hilmiyah binti Awang Husaini ◽  
Justin Fook Siong Keasberry ◽  
Khadizah Haji Abdul Mumin ◽  
Hanif Abdul Rahman
Keyword(s):  
Observational Study ◽  
Discharge Planning ◽  
Patient Factors ◽  
Medical Unit ◽  
Prolonged Length ◽  
Acute Medical Unit ◽  
Brunei Darussalam ◽  
Medical Issues ◽  
Hospital Factors ◽  
Prolonged Hospital

Background: Many patients admitted to the acute medical unit experience a prolonged length of stay in hospital due to discharge delays. Consequently, this may impact the patients, healthcare institution and national economy in terms of patient safety, decreased hospital capacity, lost patient workdays and financial performance. Objectives: The main aim of this observational study was to identify the causes of discharge delays among acute medical unit patients admitted in the Raja Isteri Pengiran Anak Saleha Hospital, Brunei. Methods: A retrospective observational study, with data of patients admitted to the acute medical unit collected from Brunei Health Information Systems between September and December 2018. Statistical analyses were performed to obtain relevant results and any statistically significant associations. Results: A total of 357 patients were admitted to the acute medical unit over the 4-month period; 218 patients (61.1%) experienced discharge delays. Of these 218 patients, 158 patients (72.5%) encountered discharge delays mainly due to intrinsic patient factors, while the discharge delays in 88 patients (40.4%) were attributed to hospital factors. The main reason for discharge delays for patient factors was slow recovery among 67 patients (30.7%), whereas for hospital factors it was the weekend limitation of services available in 23 patients (10.6%). Conclusions: There were various causes of discharge delays identified among the 218 acute medical unit patients who experienced discharge delays. Older patients with frailty, polypharmacy and complex medical issues were more likely to have a prolonged hospital stay in the acute medical unit. Stringent inclusion criteria, increasing discharge planning as well as an effective multidisciplinary approach will aid in reducing discharge delays from the acute medical unit.

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