Journal of the Royal Society of Medicine
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A large and continuing increase in medical emergency admissions has coincided with a reduction in hospital beds, putting the acute medical services under great pressure. Increasing specialization among physicians creates a conflict between the need to cover acute unselected medical emergencies and the pressure to offer specialist care. The shortage of trained nursing staff and changes in the training of junior doctors and the fall in their working hours contribute to the changing role of the consultant physician. ⋯ Excellent bed management is essential. There must be guidelines for all the common medical emergencies and all units must undertake specific audits of the acute medical service. Continuing professional development (CPD) and continuing medical education (CME) should reflect the workload of the physician; that is, it must include time specifically focused on acute medicine and general (internal) medicine, as well as the specialty interest.
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This paper examines some of the misapprehensions that have often underpinned the planning of accident and emergency services in the UK. Accident and emergency (A&E) is not a homogenous group of activities and the different components that make up the service should be planned separately. This planning needs to be accompanied by some significant redesign to meet growing patient expectations. In particular, there is a major challenge for services to offer local access in an environment in which acute care is increasingly centralized.
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The Clinical Standards Advisory Group report on urgent and emergency admissions to hospital identified several important issues regarding emergency care. This paper examines what we know about the costs of a quality emergency service. ⋯ It must, however, be recognized that such work by itself will not automatically lead to increased funding within emergency care. Further consideration must be given to the funding arrangements for emergency care if long-term improvements are to be secured.
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Gross underfunding of the National Health Service in England and Wales results in too few beds and operating theatres and too few nurses and doctors. Thus, standards of surgical care, particularly for emergencies, are compromised. ⋯ For general surgery and trauma and orthopaedics this equates to 1 consultant for 30,000 population. Emergency surgical services require the presence on site of all the core specialties, including sufficient fully staffed intensive-care, high-dependency and coronary care beds to ensure their availability for emergency admissions together with 24-hour-staffed dedicated emergency operating theatres.