Acute medical care

Editor – We read with interest the article by Ward et al (Clin Med December 2009 pp 553–6). In this article the authors identified a number of areas in which acute medical practice varies across different sites in a national survey. We have recently conducted a comprehensive regional survey in Wessex and have found similar variations. In our survey, responses were received from all nine of the acute hospitals in the region.

Eight of the nine acute units have at least one acute medicine consultant in post. The ability to recruit to these posts locally has been achieved, in part, due to the early development of a training programme in 2003. However, there remains a lack of uniformity in the structure of the services within this region. Even the titles of the units varied widely, with six different names being used; only one of the units had adopted the Royal College of Physicians (RCP) preferred title of ‘acute medical unit’ (AMU).

Although five of the nine units were purpose built, none had been able to achieve the ‘emergency floor’ model proposed in the RCP report, where co-location with critical care, emergency department and radiology was deemed desirable.¹ Near-patient testing was available in eight of the nine units, compared to <50% in the national survey. Six provided an ambulatory care service, eight provided direct general practitioner access and all used an early warning score for prediction of illness severity. Links with pharmacy were particularly strong in our survey, with all AMUs providing a dedicated pharmacy service. However, only one of the units was able to provide a dedicated AMU physiotherapist, and a weekend therapist was provided in only four units.

Ward et al emphasise the progress that acute medicine has made over the last 10 years, but a uniform service across the UK remains some distance away. Indeed, it is likely that their results underestimate the national variations given that 31% of the hospitals failed to respond. Hospitals without a coherent, structured acute medicine service may have been less likely to respond to an acute medicine survey. Collating data on a regional basis may be one way to achieve a higher response rate, as achieved in our survey.