Acute medicine

Acute medicine is that part of internal medicine concerned with the immediate and early specialist management of adult patients with a wide range of medical conditions who present in hospital as emergencies.^[1] It developed in the United Kingdom in the early 2000s as a dedicated field of medicine, together with the establishment of acute medical units in numerous hospitals.^[1] Acute medicine is not identical to emergency medicine, which is limited to the management of people attending the emergency department.^[1]

History

The field developed in the United Kingdom after the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow published a joint report in 1998 emphasising the importance of appropriate care for people with acute medical problems.^[1][2] Further reports led to the development of acute medicine as a dedicated specialty, and in 2003 it was recognised by the Specialist Training Authority as a subspecialty of general medicine.^[1]

Around the same time, it was recognised that care for acutely admitted patients should ideally be concentrated in "medical assessment units" (MAUs). A physician experienced in the management of acute medical problems could assess and treat these patients in the most appropriate fashion for the first 48 hours of their admission, aiming either for an early discharge with appropriate outpatient follow-up or transfer to a specialist ward.^[1]

In 2007, some questioned whether the specialty would have a long term future, if at some point UK government ED targets ceased to exist.^[3] This fear seems unwarranted in retrospect, as a clear clinical need for the specialty exists.^{[citation needed]}

A further development has been the increase of ambulatory care. Where patients were previously admitted to hospital, it may now be possible for them to attend a clinic or an assessment area a number of times while their progress is monitored.^[1] This is now a very common approach to suspected deep vein thrombosis.^{[citation needed]}

The establishment of acute medical units has been shown to improve the risk of dying in hospital, length of stay in hospital, and the rate of patients for admission blocking the emergency department, all while not increasing the rate of readmissions after discharge and improving patient and staff satisfaction.^[4]

Organisations

In the United Kingdom, the Society for Acute Medicine is the specialist association for acute medicine. It organises two annual conferences.

References

1. ^ ^{a b c d e f g} Dowdle JR (November 2004). "Acute medicine: past, present, and future". Emerg Med J 21 (6): 652–3. doi:10.1136/emj.2003.012211. PMC 1726512. PMID 15496684. http://emj.bmj.com/cgi/content/full/21/6/652. 
2. ^ Royal College of Physicians (April 1998). Acute Medical Admissions and the Future of General Medicine. Edinburgh and Glasgow: Scottish Intercollegiate Working party. 
3. ^ Stein A, Henley J (May 2007). "Acute medicine: do we need 'medical traffic wardens' to make us interested in general medical patients?". QJM 100 (7): 463–464. doi:10.1093/qjmed/hcm037. PMID 17491101. 
4. ^ Scott I, Vaughan L, Bell D (December 2009). "Effectiveness of acute medical units in hospitals: a systematic review". Int J Qual Health Care 21 (6): 397–407. doi:10.1093/intqhc/mzp045. PMID 19903756. http://intqhc.oxfordjournals.org/content/21/6/397.full. 

External links

• Society for Acute Medicine