Acute medicine

Acute medicine is that part of internal medicine concerned with the immediate and early specialist management of adult patients with a wide range of medical conditions who present in hospital as emergencies.[1] It developed in the United Kingdom in the early 2000s as a dedicated field of medicine, together with the establishment of acute medical units in numerous hospitals.[1] Acute medicine is distinct from the broader field of emergency medicine, which is concerned with the management of all people attending the emergency department, not just those with internal medicine diagnoses.[1] The emergence of acute medicine has both similarities with and differences from hospital medicine in North America, reflecting health system differences.[2]

History

The field developed in the United Kingdom after the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow published a joint report in 1998 emphasising the importance of appropriate care for people with acute medical problems.[1][3] Further reports led to the development of acute medicine as a dedicated specialty, and in 2003 it was recognised by the Specialist Training Authority as a subspecialty of General Internal Medicine.[1]

Around the same time, it was recognised that care for acutely admitted patients should ideally be concentrated in "medical assessment units" (MAUs), later named "acute medical units" (AMUs). A physician experienced in the management of acute medical problems could assess and treat these patients in the most appropriate fashion for the first 48 hours of their admission, aiming either for an early discharge with appropriate outpatient follow-up or transfer to a specialist ward.[1] Severely ill patients who need close observation but do not require intensive care may be treated in a dedicated area such as a physician-run high-dependency unit.[4]

In 2007, some questioned whether the specialty would have a long-term future, if at some point UK government ED targets ceased to exist.[5] This fear seems unwarranted in retrospect, as a clear clinical need for the specialty exists.[2]

A further development has been the increase of ambulatory care. Where patients were previously admitted to hospital, it may now be possible for them to attend a clinic or an assessment area a number of times while their progress is monitored.[1][4] This is now a very common approach to suspected deep vein thrombosis,[6] but the NHS Institute for Innovation and Improvement has identified a number of other conditions that can be managed in an ambulatory emergency care setting.[7]

Acute Medicine became a specialty in a similar way to cardiology and respiratory medicine, with its own Certificate of Completion of Training (CCT) in 2009.[8][9]

The establishment of acute medical units has been shown to decrease the risk of dying in hospital, length of stay in hospital, and the rate of patients for admission blocking the emergency department, all while not increasing the rate of readmissions after discharge and improving patient and staff satisfaction.[10]

Organisations

In the United Kingdom, the Society for Acute Medicine (SAM) is the national representative body for staff caring for medical patients in the acute hospital setting. Formed in 2000, SAM was established at a time when the concepts of acute medicine and the Acute Medical Unit (AMU) were in their infancy. Large numbers of specialist acute physicians have been appointed to drive forward changes in the management of patients on the AMU, and several hundred specialist registrars are now training on the newly approved Curriculum in Acute Internal Medicine. SAM has played a pivotal role in many of these developments and is represented on many national committees enabling a strong voice for acute physicians within the Royal Colleges and other key organisations. It organises two annual conferences (Spring and Autumn) and publishes the quarterly journal Acute Medicine.

In the Netherlands, the Dutch Acute Medicine (DAM) society was formed in 2012 and held its first Congress on 28 September 2012 in the VU University Medical Center in Amsterdam. The newly developed curriculum will ensure 12 training posts throughout the Netherlands leading to a workforce of at least 100 "acute & internal medicine specialists".[11]

References
  1. Dowdle JR (November 2004). "Acute medicine: past, present, and future". Emerg Med J. 21 (6): 652–3. doi:10.1136/emj.2003.012211. PMC 1726512. PMID 15496684.
  2. Wachter RM; Bell D (2012). "Renaissance of hospital generalists". BMJ. 344: e652. doi:10.1136/bmj.e652. PMID 22331278. S2CID 206896335.
  3. Royal College of Physicians (April 1998). Acute Medical Admissions and the Future of General Medicine. Edinburgh and Glasgow: Scottish Intercollegiate Working party.
  4. Royal College of Physicians (2007). Acute Medical Care. London: Royal College of Physicians of London. ISBN 978-1-86016-321-0.
  5. Stein A, Henley J (May 2007). "Acute medicine: do we need 'medical traffic wardens' to make us interested in general medical patients?". QJM. 100 (7): 463–464. doi:10.1093/qjmed/hcm037. PMID 17491101.
  6. Winter M, Keeling D, Sharpen F, Cohen H, Vallance P (February 2005). "Procedures for the outpatient management of patients with deep venous thrombosis". Clin Lab Haematol. 27 (1): 61–6. doi:10.1111/j.1365-2257.2004.00660.x. PMID 15686510.
  7. "Ambulatory emergency care homepage". NHS Institute for Innovation and Improvement. Retrieved 2013-08-08.
  8. "Acute medicine". Royal College of Physicians. Retrieved 2013-08-08.
  9. "Acute Internal Medicine (AIM) and sub-specialty of Acute Medicine". Joint Royal Colleges Postgraduate Training Board. Archived from the original on 2012-10-26. Retrieved 2013-08-08.
  10. Scott I, Vaughan L, Bell D (December 2009). "Effectiveness of acute medical units in hospitals: a systematic review". Int J Qual Health Care. 21 (6): 397–407. doi:10.1093/intqhc/mzp045. PMID 19903756.
  11. "Dutch Acute Medicine". Retrieved 2013-08-08.
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