Acute medicine in the United Kingdom: First‐hand perspectives on a parallel evolution of inpatient medical care

Smith, G. Randy; Stein, Jason; Jones, Mike

doi:10.1002/jhm.1006

Cited by 4 publications

(10 citation statements)

References 17 publications

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“…Commitment to the general medical on-call rota and the associated burden of service provision is, however, perceived by some trainees as leading to reduced academic and training opportunities -this was considered an important downside to a career in the specialty [16]. In some countries the progressive sub-specialisation of single organ specialists has resulted in the formation of a service gap, which has subsequently been filled by newly conceived specialties such as Acute Medicine [19]. At best, these specialties have recognised the knowledge and skillsets required to care for older patients, and are up-skilling appropriately.…”

Section: Post-graduate Geriatric Medicine Training Across Europementioning

confidence: 99%

New horizons in geriatric medicine education and training: The need for pan-European education and training standards

Fisher

Masud

Holm

et al. 2017

European Geriatric Medicine

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Section: Post-graduate Geriatric Medicine Training Across Europementioning

confidence: 99%

New horizons in geriatric medicine education and training: The need for pan-European education and training standards

Fisher

Masud

Holm

et al. 2017

European Geriatric Medicine

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“…In the UK some medical specialties require training in IM as well (Smith et al . ); thus similar conflicts may emerge in UK hospitals. Shared training experiences confuse jurisdictional claims over patients.…”

Section: Discussionmentioning

confidence: 93%

“…) and abroad (Smith et al . ). This collaboration within medical work has both sociological and policy relevance.…”

mentioning

confidence: 97%

“…The findings of this study are likely to resonate beyond the USA as a result of the increased specialisation of the medical profession worldwide (Smith et al . ).…”

mentioning

confidence: 97%

“…What are the professional consequences of hospital physicians relying on other physicians to provide patient care? The increased specialisation of medicine, the emergence of new medical technologies and the complex nature of chronic conditions associated with longer life spans have made collaboration among specialists an integral aspect of care delivery in the USA (Wennberg et al 2008) and abroad (Smith et al 2012). This collaboration within medical work has both sociological and policy relevance.…”

mentioning

confidence: 99%

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Hospital consultations and jurisdiction over patients: consequences for the medical profession

Oh¹

2013

Sociology Health & Illness

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Advances in biomedical technologies and the increased specialisation of the medical profession have made collaborations among specialty physicians integral to care delivery. As physicians increasingly must share patients, how does this shape the jurisdiction that physicians hold? The sociological literature has extensively documented inter-professional jurisdictional claims and conflicts to maintain the professional power of physicians in relation to allied occupational groups. However, less is known of intra-professional avoidance and resolution of conflict over jurisdiction. This case study considers how jurisdictions are shared, maintained and challenged in a single profession. Drawing from ethnographic and interview data collected from September 2010 to October 2012 on the internal medicine service of a teaching hospital in the USA, I demonstrate the variation in jurisdictional conflicts that emerge between internal medicine and other specialties during the consultation process. Ignoring shared jurisdictions and refusing to accept jurisdiction of patients generate disputes among the principal medical and specialist teams. These disputes ensue due to blurred boundaries dividing the various specialties. To avoid conflicts, internal medicine physicians adopt strategies behind the scenes to facilitate smooth consultations.

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Association of hospital admission service structure with early transfer to critical care, hospital readmission, and length of stay

Smith

Hansen

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process. OBJECTIVE To compare the effect of 2 hospitalist admission service models (“general” and “admitter‐rounder”) on patient disposition and length of stay. DESIGN Retrospective observational cohort study with difference‐in‐difference analysis. SETTING Large tertiary academic medical center in the United States. PARTICIPANTS Patients (n = 19,270) admitted from the emergency department to hospital medicine and medicine teaching services from July 2010 to June 2013. INTERVENTIONS Admissions to hospital medicine staffed by 2 different service models, compared to teaching service admissions. MEASUREMENTS Incidence of transfer to critical care within the first 24 hours of hospitalization, hospital and emergency department length of stay, and hospital readmission rates ≤30 days postdischarge. RESULTS The change of hospitalist services to an admitter‐rounder model was associated with no significant change in transfer to critical care or hospital length of stay compared to the teaching service (difference‐in‐difference P = 0.32 and P = 0.87, respectively). The admitter‐rounder model was associated with decreased readmissions compared to the teaching service on difference‐in‐difference analysis (odds ratio difference: −0.21, P = 0.01). Adoption of the hospitalist admitter‐rounder model was associated with an increased emergency department length of stay compared to the teaching service (difference of +0.49 hours, P < 0.001). CONCLUSIONS Rates of transfer to intensive care and overall hospital length of stay between the hospitalist admission models did not differ significantly. The hospitalist admitter‐rounder admission service structure was associated with extended emergency department length of stay and a decrease in readmissions. Journal of Hospital Medicine 2016;11:669–674. © 2016 Society of Hospital Medicine

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Acute medicine in the United Kingdom: First‐hand perspectives on a parallel evolution of inpatient medical care

Cited by 4 publications

References 17 publications

New horizons in geriatric medicine education and training: The need for pan-European education and training standards

New horizons in geriatric medicine education and training: The need for pan-European education and training standards

Hospital consultations and jurisdiction over patients: consequences for the medical profession

Association of hospital admission service structure with early transfer to critical care, hospital readmission, and length of stay

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