Journal of the Royal Society of Medicine
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The maternal mortality rate was the first measure of quality in the obstetric services. It is a crude indicator but is still used for international comparisons. ⋯ The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have jointly published standards of care in labour wards. Gynaecological standards are less well developed but should evolve as NHS audit improves.
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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.
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The primary objectives of the emergency services are to minimize early mortality and complications, although longer-term morbidity, quality of life and late mortality may also be influenced by early actions. Evaluation of the emergency services and demonstration of quality need to reflect these objectives by appropriate choice of outcome measures. ⋯ The review also discusses capacity, a necessary requirement for a quality service, and operations research/queuing theory to facilitate management of capacity/resources to meet fluctuating demands. The NHS should be able to plan for seasonal needs.
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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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The interface between primary and secondary care in the UK has been affected by a number of recent changes, particularly in provision of out-of-hours care and advice. This paper reviews some current measures of healthcare quality and argues that many do not adequately measure contributions in primary care. To overcome these deficiencies the Royal College of General Practitioners (RCGP) has published guidelines on issues of quality in primary care.