Acute Medicine: Better And Safer What have we done and where we go from here?
Philip Dyer Past President Society for acute Medicine
The Society for ...
Acute Medicine: Better And Safer What have we done and where we go from here?
Philip Dyer Past President Society for acute Medicine
The Society for Acute Medicine, 5th International Conference, Imperial College London 29-30 September 2011
The Vision for SAM • Research
• Influencing the agenda • Training and Professional Development • Courses
• Standards of care, patient safety and quality • Meetings
Research •
PE survey
•
An Evaluation of Consultant Input into Acute Medical Admissions Management in England. Report of: Hospital service patterns vs. clinical outcomes in England
•
Management of Acute Alcohol intoxication
•
The ambulatory care survey
•
AF Survey
•
Systematic review of AMUs
Recent and Current projects with SAM involvement NHS Clinical Knowledge Summaries
Influencing the Agenda
NHS Connecting for Health IT Survey of Specialist Societies Emergency Admission to Medicine workshop (RCPI) BTS Guidelines for the Management of Community Acquired Pneumonia in Adults 2009
Centre for Work Force Intelligence
Acute Kidney Injury Care Initiative
RCPL Acute Medicine Committee
National Conference - Acute Medicine and Frail Older People
NICE – Neutropenic Guidelines
Neurology Services in the DGH working party (RCPL) Putting feet first – Diabetes UK & NHS Diabetes Ultrasound/Echocardiography training for Acute Physicians Sub-Group BTS Guidelines for Management of Pleural Disease
NICE – Hyperglycaemias and ACS NHS Diabetes National DKA Guidelines RCPL and DOH and SAM Clinical Indicators for Acuter Internal Medicine
SRCs Meeting with Specialist Societies Specialty CPD Representatives’ Group RCP Revalidation for Specialty Societies Coalition of Medical Societies National Encephalitis Guidelines Group Standardized Methods for Implementation of OPAT (Out-Patient Parenteral Antimicrobial Therapy) Services in the United Kingdom Emergency Care Specialist Library Reference Group National Patient Safety Association
BTS Oxygen Guidelines NHS London – Clinical Expert Panel on Acute Care Silverbook for Acute Elderly Care NCEPOD
Influencing the Agenda
Training and Professional Development Specialty Advisory Committee Person
Position
Representing
Dr Michael Chave Jones
Chair
NHS Education for Scotland
Dr Ian Graeme Barrison
Co-opted Member
SAC G(I)M
Dr Brian Eamonn Bourke
Co-opted Member
SAC G(I)M
Brig Peter John Fabricius
Lead Dean
COPMeD
Dr Martin Christopher Culshaw
Member
East Midlands Deanery
Dr Nicola Jane Doddridge
Member
Yorkshire and Humber Deanery
Dr Roger Wellesley Duckitt
Member
Kent, Surrey and Sussex Deanery
Dr Philip Henry Dyer
Member
West Midlands Deanery
Dr Mark Edward Holland
Member
North Western Deanery
Dr John William Lorains
Member
Mersey Deanery
Dr William John Lusty
Member
South Western Representative
Dr Darren Michael McLaughlin
Member
Northern Ireland Medical and Dental Training Agency
Dr Paresh Dharampal Mistry
Member
London
Dr Russell James O'Brien
Member
Peninsula Deanery
Dr Samir Kumar Patel
Member
Severn Deanery
Professor Timothy Edward Alexander Peto
Member
Oxford Deanery
Dr Ian Paul Reckless
Member
Oxford Deanery
Dr Christopher David Roseveare
Member
Wessex Deanery
Dr Joanne Louise Southgate
Member
East of England Deanery
Dr Michael John Webberley
Member
Welsh School of Postgraduate Medical and Dental Education
Dr Brian Haydon Wood
Member
Northern Deanery
Dr Timothy Alexander Bonnici
Trainee Representative
Trainee's Committee
Training and Professional Development
SAM Rebranding Meeting 2010 1. Produce a consistent communication message for our stake holder Our funders Our collaborators Our customers Our staff Our suppliers Completed 2. Review committee structure and constitution Completed 3. Write a JD for the Communications Director Completed 4. Appointment of a Communications Director through interview SAM Council Media and Communications Officer appointed 5. Development of a new logo Old logo was preferred choice and has been updated 6. Directory of all AMUs on the website Outstanding 7. Produce a members pack Outstanding – deadline 8. Development Facebook and Twitter sites Completed 9. Develop a uniform of approach to all our materials Completed 10. A sponsor’s pack to explain what SAM is Completed 11. Present the revised committee structure at the SAM AGM Completed 12. Present new SAM brand at International meeting in Edinburgh SAM Council Completed
OTHER ACHIEVEMENTS • Employed our own administrator • Rent our own office space • Become a registered company
SAM Strategy Meeting July 2011 •
Commission data to continue to develop a strong evidence base to prove worth of AIM.
•
Surveys of members and other healthcare professional re their understanding of acute medicine
•
Research into developing a management courses
•
Exploration into the benefits becoming a charitable organisation
Develop policy statement s on key issues - seven day working must be developed – Core group formed who will discuss relevant issues and decide on policy/action. – Issues on the table; seven day working, NHS white paper, emergency readmissions
•
To create person specifications for AIM consultant to send to: – Members – NHS Managers – Foundation Trusts
•
Definition to be redeveloped.
Society for Acute Medicine It is acknowledge there is a need to care for patients with Still lack of clear definition from EM or acute medical illnesses GIM Exciting and interesting specialty Key to the performance of hospitals Innovative Networking Conferences
Can do attitude Hardworking Committed workforce Expanding specialty Influence nationally – DoH, Royal Colleges, NICE etc Research Service development Ambulatory Care AMU registry and database
Clinical Indicators AMU Quality standards 7-day working NHS funding – requirement for cost savings
Infrastructure Research base Confusing nomenclature Inconsistent message Communication
Everyone want to do front door work • Elderly Care – „The Silverbook‟ • Cardiology – expansion of the CCU • Being insula and not open to change
How can we help you?
• Nursing Workforce planning for the AMU • Example rotas for 7-day consultant working • Person specs for acute medicine consultants • AMU Standards • Acute Internal Medicine Clinical Quality Indicators
Principles of an Ideal Acute Medicine Consultant Rota Consultant Cover • 12 hours per day • 7 days per week • 0800h – 2000h (some centres may need cover until 2200h) • Cover up to 2200h will require 2 consultants on a split shift e.g. – 0800h – 1600h – 1400h – 2200h Ward Rounds • 2 per day (all patients on the AMU must be reviewed twice per day)
Number of days of continuous cover • 3-5 days blocks
Principles of an Ideal Acute Medicine Consultant Rota Number of patient contacts • 40 – 50 • 12 hours at 4 contacts per hour (every 15 minutes) equates to 48 patients • 15 minutes for a new patient • 10 minutes for a review of a patient Freed up from all clinical duties If the centre assesses more than 30 patients between 0800-2000h there should be 2 consultants on call • 30 patients will equate to 60 patient contacts which exceeds the optimum number of contacts
Acute Internal Medicine Clinical Quality Indicators 1. All patients should have an assessment and a management plan instigated within 4 hours of arrival to the AMU.
2. Patients should be reviewed by the admitting consultant physician or an appropriate speciality consultant physician within 14 hours of their arrival on the AMU.
3. All patients should have an early warning score measured at the point of entry to the AMU. 4. Regular monitoring of key performance indicators in acute care should be performed.
• •
•
Hospital mortality rates for all patients admitted via the AMU Proportion of patients discharged from the AMU within 48 hours of admission Proportion of patients readmitted to hospital within 7 days of discharge
Remember
It is AMU (Acute Medical Unit)
“I am a success today because I had a friend who believed in me and I didn't have the heart to let him down...”
• Thanks • Christine Lawson and the Eventage team • Council members • SAM members
Also remember…. • Conference Dinner in the Senior Common Room at 1930 – few tickets available • Early morning Sessions at 0800 tomorrow– not fully booked, so come for coffee & choose your session SEE YOU TOMORROW…..
