Redesigning acute medical care
Is the subject of a new report ‘Acute medical care: The right person, in the right setting, first time’ from the Royal College of Physicians.
Ill people should be directed as soon as possible to the most appropriate clinical decision maker who can diagnose their condition accurately and start treatment. This should happen no matter what time of day it is and be supported by round-the-clock diagnostic facilities for both community and hospital-based care.
Something we can all sign up to. People do not develop illnesses timed by the clock. However I would be careful about giving the impression that full-service medical care 24/7 is affordable, even it is possible.
The report says that out-of-hours care outside of hospitals is largely inadequate and inflexible, so patients go to hospitals because there is nowhere else for them to go to get the reassurance and care they need. We need an expansion in the range of services, providers and facilities offering immediate acute medical care outside traditional hospitals, but this expansion should be evidence-based and shown to work before any existing services are removed.
The 2003 GP contract could have been the vehicle for a considered reform of emergency service provision, instead of which a cost-cutting exercise has been undertaken. Evidence-based is the key word here. As is education, helping the public understand that they will need to take some responsibility for their own health.
The first question the Acute Medicine Task Force set out to answer was “If I were really ill, what would I want to happen?”
And this is why clinicians need to be central to service design & management, being closest to the patient while also able to balance other constraints. I suspect that the Task Force have not been as radical as I would like but they have had to work within the confines of what is possible rather than what would be ideal.
A few of the recommendations:
* A local “navigation hub” with a local, well-publicised telephone number to direct patients to the most appropriate service, linked to a more locally relevant NHS Direct.
A single telephone number nationally with IVR geographic targeting would be my preference. Regional telephone advisory services with specific geographic knowledge of service availability would be advantageous. NHS Direct as a concept is incomplete.
* In large acute hospitals, the ‘front door’ should comprise an ‘emergency floor’ including the emergency department, acute medical unit, critical care and ambulance services - this will make it easier for patients to get to the right place quickly.
Blindingly obvious & something that should have been present for a long time, even in converted Victorian buildings. Hospital design has not changed all that much in the last few years.
* Nationally standardised assessment, documentation, and clinical management of common acute medical conditions to reflect best practice.
Agree with this to a degree subject to the usual caveats about standardised protocols. There are always exceptions & sensible local adaptation helps.
Going back to the totality of the report I would hope that it has been screened also for political impact. The days of medicine being above politics are over & it is possible for otherwise innocuous sounding material to be used for political purposes. Now we wouldn’t want that, would we?
November 12th, 2007 at 1:04 pm
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