Acute medicine
Encyclopedia
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
. 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. Acute medicine is not identical to emergency medicine
, which is limited to the management of people attending the emergency department
.
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. 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 medicine
.
Around the same time, it was recognised that care for acutely admitted patients should ideally be concentrated in "medical assessment units" (MAUs). 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.
In 2007, some questioned whether the specialty would have a long term future, if at some point UK government ED targets ceased to exist. This fear seems unwarranted in retrospect, as a clear clinical need for the specialty exists.
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. This is now a very common approach to suspected deep vein thrombosis
.
The establishment of acute medical units has been shown to improve 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.
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
concerned with the immediate and early specialist management of adult patients with a wide range of medical conditions who present in hospital as emergencies
Medical emergency
A medical emergency is an injury or illness that is acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the...
. It developed in the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
in the early 2000s as a dedicated field of medicine, together with the establishment of acute medical units in numerous hospitals. Acute medicine is not identical to emergency medicine
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
, which is limited to the management of people attending the emergency department
Emergency department
An emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
.
History
The field developed in the United KingdomUnited Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
after the Royal College of Physicians of Edinburgh
Royal College of Physicians of Edinburgh
The Royal College of Physicians of Edinburgh was established in the 17th century. While the RCPE is based in Edinburgh, it is by no means just a Scottish professional body - more than half of its 7,700 Fellows, Members, Associates and Affiliates live and practice medicine outside Scotland, in 86...
and the Royal College of Physicians and Surgeons of Glasgow
Royal College of Physicians and Surgeons of Glasgow
The Royal College of Physicians and Surgeons of Glasgow, is an institute of physicians and surgeons in Glasgow, Scotland.Founded by Peter Lowe after receiving a royal charter by James VI in 1599, as the Glasgow Faculty, this institution originally existed as a regulatory authority to ensure that...
published a joint report in 1998 emphasising the importance of appropriate care for people with acute medical problems. 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 medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
.
Around the same time, it was recognised that care for acutely admitted patients should ideally be concentrated in "medical assessment units" (MAUs). 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.
In 2007, some questioned whether the specialty would have a long term future, if at some point UK government ED targets ceased to exist. This fear seems unwarranted in retrospect, as a clear clinical need for the specialty exists.
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. This is now a very common approach to suspected deep vein thrombosis
Deep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
.
The establishment of acute medical units has been shown to improve 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.