QJM : monthly journal of the Association of Physicians
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Review
An international study of the quality of national-level guidelines on driving with medical illness.
Medical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised. ⋯ This study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.
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Early consultant review has been shown to improve outcomes in patients presenting to the Acute Medical Unit (AMU). The Society for Acute Medicine (SAM) clinical quality indicators use the time of arrival on the AMU for target rather than arrival in the Emergency Department (ED) although this is where most acute medical patients present. ⋯ A 7-day Acute Physician working model is improving performance with regards to patient waiting times. We suggest that starting the clock for acute medical patients in the ED is a better measure of performance than on arrival to the AMU.
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Multicenter Study
A cross-sectional study of doctors', managers' and public representatives' views regarding acceptable level of risk in discharges from the emergency department.
Discharging a patient from the emergency department (ED) always involves some risk of a poor outcome. ⋯ There are significant differences in risk tolerance when considering discharge from the ED between different groups with doctors being most risk tolerant and politicians most risk averse.