A new survey from the Royal College of Physicians of the way care for very ill patients is managed in England, Wales and Northern Ireland recommends that hospitals need to increase the availability of senior doctors in acute admissions units, particularly at weekends. Previous studies show that a consultant-delivered service is best for patient treatment and recovery.
Representatives of 126 hospitals from 109 different Trusts or equivalents completed the survey – 114 from England, 6 from Northern Ireland and 6 from Wales. The survey did not cover Scotland.
Care for very ill patients has improved significantly over the past few years due both to the introduction of acute medical admissions units in most major hospitals, and a major increase in the number of consultant physicians specialising in acute medicine to assist other hospital specialists working in acute medical admission units. Despite these changes, many patients are only seen once per day in a formal ward round instead of the recommended two daily ward rounds. In three-quarters of the acute medical admissions units accepting patients directly from GPs, the unit runs out of beds, so the report recommends that there are sufficient beds in future to ensure that very ill patients gain appropriate access to acute admissions wards.
Nearly half (48%) of consultant physicians responsible for assessing and treating patients on their arrival at the acute medicine ward (the “acute take”) still have to do routine clinics or other parts of their job as well as at the same time seeing the urgent patients. These duties should be cancelled on those days to allow physicians to concentrate wholly on the very ill patients.
Only 3% of hospitals provided weekend cover from consultant physicians specialising in acute medicine for 9–12 hours and none for over 12 hours. Nearly three-quarters of hospitals in the survey had no cover from consultant physicians specialising in acute medicine over the weekend.
Dr Jonathan Potter, Clinical Director of the RCP’s Clinical Effectiveness and Evaluation Unit, said:
Despite improvements in facilities and staffing, hospitals still need to address working arrangements to ensure that senior doctors are readily available to provide a consultant led service in acute medical admissions units 7 days a week.
In a major accompanying statement, RCP President Sir Richard Thompson said that patients deserve better care at night and at weekends, as the RCP recommends for the first time that consultant physician cover is available in hospitals every day for 12 hours per day.