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Safety in numbers: lack of evidence to indicate the number of physicians needed to provide safe acute medical carePatient safety in hospital is dependent on a multitude of factors. Recent reports into the failings of healthcare organisations in the UK have highlighted low staffi ng levels as a signifi cant factor. There is research into the impact of nurse-to-patient ratios on patient safety, but our literature search found little published data that would allow healthcare providers to defi ne a minimum number of physician staff and skills mix that would assure safety in the largest hospital specialty: unscheduled (acute) medicine. Future work should focus on the evaluation of existing data on hospital mortality rates and physician staffi ng levels as well as on empirical time and motion studies to ascertain the resources required to undertake safe medical care at times of peak demand. KEYWORDS: Mortality, personnel staffi ng and scheduling, workload, patient safety Background The political contextSafe staffi ng levels in acute care is a subject of intense debate, particularly since the Francis report identifi ed inadequate staffi ng levels as one of the key factors that led to poor quality care at Mid Staffordshire NHS Trust. 1 The Review into the quality care and treatment provided by 14 hospital trusts in England, led by Sir Bruce Keogh, similarly pointed to the impact of workforce issues on hospital mortality, with inadequate levels of available staff, a reliance on locum or temporary staff and the poor provision of weekend and night cover being key issues. 2 The report particularly emphasises the diffi culties in adequately supporting frontline nurses and junior doctors, who shoulder the main burden of acute and emergency care.One of Francis' recommendations was that there should be evidence-based tools for establishing the staffi ng needs of each service. 1 The report into patients' safety commissioned by the Department of Health and undertaken by Don Berwick also recommended that organisations should ensure that staff are available in appropriate numbers to provide safe care and suggested a NICE review into staffi ng numbers. 3 Currently, there is very little guidance regarding safe physician staffi ng levels in acute medical care. Current recommendationsThe Royal College of Physicians (RCP) recommends that there should be consultant presence on the acute medical unit (AMU) for a minimum of 12 hours per day, 7 days per week. 4,5 The number of consultants involved daily on the AMU should refl ect pro rata the number of patients expected to attend. 6 In the 2010 edition of its document Consultant physicians working with patients: acute internal and general internal medicine, the RCP recommended that a foundation or core medical training (CMT) doctor should be allowed 1 hour to complete the formal assessment of a patient presenting to hospital with an acute medical problem. This recommendation was extended to 1.5 hours in the 2013 edition of the same document, based on anecdotal evidence alone. 5 We aimed to...

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