Clin Med
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Medical education is vital to the future of healthcare provision. It is also expensive. ⋯ Educational budgets should be transparent - so that their use and misuse are clear. We should develop a culture of lifelong learning and continually make explicit that future healthcare professionals need investment in their education to maintain the quality and safety of healthcare delivery.
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The decision to admit a frail older patient is rarely made by a geriatrician and often falls to staff in the emergency department (ED), who may not have the training to balance the risks, benefits and alternatives. We based a consultant geriatrician in the ED with the primary aim of facilitating admission prevention for older patients and this was achieved for 64% (543/848) of patients. ⋯ The overall 7-day ED re-attendance rate was 10.1%, but only 3.4% of patients were admitted with the same problem, indicating true admission prevention rather than admission delay. In conclusion, the placement of a consultant geriatrician in the ED is effective in facilitating admission prevention for older patients.
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We describe the case of a woman who presented with seemingly non-specific symptoms, including collapse, but through examination was eventually revealed to have an unusual, potentially fatal, but treatable neurological condition. We share some thoughts on the process of diagnosis, the difficulty of diagnosing a rare disease and the practice of neurology on the acute medical take. We also highlight the value of screening neurological examination in acute medical patients.
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Comparative Study
The quality of patient experience of short-stay acute medical admissions: findings of the Adult Inpatient Survey in England.
Introduction of the specialty of acute medicine and of acute medical units (AMUs) in the UK have been associated with improvements in mortality, length of stay and flow, but there is no literature on the patient experience during the early phase of acute medical admissions. We analysed the Adult Inpatient Survey (AIPS) findings for short-stay unscheduled medical admissions who did not move from their first admission ward (n=3325) and therefore are likely to have been managed entirely in the AMU. ⋯ Scores for unscheduled admissions were worse in medical patients compared with other specialties for pain control, privacy, involvement, information, and for a number of questions relating to information on discharge. The specialty of acute medicine should work to improve future patient experience.