http://bmj.com/cgi/content/full/325/7356/122
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Claire McKenna BMJ
The standard of care received by acutely ill medical inpatients in the United Kingdom is below acceptable standards, says a new report on the interface between acute general medicine and critical care, commissioned by the Royal College of Physicians.
The current emphasis on specialist training of doctors rather than generic skills is not the correct approach to intensive medical management, says the report. All doctors should be trained at senior house officer level in the care of the severely ill patient, it says.
The report recommends the introduction of early warning scoring systems appropriate for severely ill medical patients. It also advises that junior medical, nursing, and allied health professionals, such as physiotherapists, should be trained in the use of such systems.
The working party that drew up the report also thought that consultant physicians should move to a dedicated on-call system where their sole responsibility was towards supporting emergency work.
A major focus of the report was the standard of training in critical care. The working party recommended that training in the recognition and management of acutely ill patients should begin in medical school and that all undergraduates should receive advanced life support training.
It also suggested that:
· Medical schools consider developing training modules that focus on the knowledge and skills needed in the initial assessment of severely ill people;
· Postgraduate deans adopt locally one of the nationally available generic training schemes (such as the acute life threatening events—recognition and treatment (ALERT) programme), designed to teach a systematic approach to the assessment and care of severely ill people;
· It should become mandatory to hold a certificate of completion of a course, such as ALERT, to progress beyond the senior house officer year.
The royal college has also issued a report showing that acutely ill patients often find themselves in a gap between acute medicine and accident and emergency, something partly attributed to the division between the two. The report advises that patients would benefit from a continuum of care so that they can move safely and easily from one part of the hospital to the next.
‘The interface between acute general medicine and critical
care’ and ‘The interface of Accident and Emergency and acute medicine’ are
available, price £7 each, from the RCP publications department 020 7935 1174 x.
358 or summaries are available at
www.rcplondon.ac.uk
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