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Medical wards have to be radically restructured

A radical restructuring of the wards where acutely ill patients are treated is needed, under a new organisational and management structure that will integrate hospital and community care.

The move towards a more joined up local healthcare system is being urged by a Future Hospital Commission report.

Continuity of care is a key aim, with care coming to the acutely ill patient, rather than the patient being moved around the hospital.

Acute Care Hubs need to be developed within hospitals, incorporating acute medical units, ambulatory care and short-stay wards to ensure highly co-ordinated, efficient care of patients admitted to hospital in an emergency, seven days a week.

The report makes 50 recommendations aimed at improving care for acute medical patients with the aim of putting patient experience and the concept of ‘clinician citizenship’ back to the heart of healthcare.

The independent Future Hospital Commission was established by the Royal College of Physicians in March 2012 to find solutions to the current challenges facing the NHS – a rising tide of acute admissions, the increasing number of patients who are frail, old, or who have dementia, patients with increasingly complex illnesses, systemic failures of care, poor patient experience, and a medical workforce crisis.

The Commission brought patients and medical and healthcare experts together to develop  a vision for the Future Hospital covering both how patients should be cared for, and the changes in organisation and staffing that would support the new vision.

The recommendations for getting specialist medical teams to work with partners in primary and social care to support patients outside hospital include:

– A new Medical Division in each hospital caring for medical patients, with care responsibilities that reach outside the hospital into the wider health community;

– A new Acute Care Hub which will include the acute medical unit, short-stay wards, enhanced care beds (level 1) and ambulatory emergency care;

– A Clinical Coordination Centre which will act as a central control room for real-time patient information, handover and transfer briefings, and organisation of care for all acutely ill medical patients , whether inside or outside the hospital;

In terms of workforce development, it suggests changes to the working patterns and responsibilities of other doctors within the hospital.

The report proposes two new roles – the Chief of Medicine and the Chief Resident. The former will have ultimate responsibility for all adult patients with a medical illness, and the latter is responsible for liaising with junior doctors in the Medical Division and help plan service design and delivery, including rotas, duties and workload.

Consultant physicians in medical specialties will spend time in the acute care hub, providing specialist opinion and care. More  ‘generalists’ are needed and specialists will have to provide more support to the acutely ill.

Sir Michael Rawlins, chair, Future Hospital Commission, said: “This report has major implications for the clinical practice of physicians, the training of future generations of physicians, for research and – most importantly of all – for patients.  Its implementation will be a challenge for us all – but implement it we must.  Our present and future patients will expect – indeed demand – no less.”

Recommendations for patients:

– Care should come to the patient, and the patient should not be moved unless it is absolutely necessary for their care;

– The patient experience should be as important as their clinical outcomes;

– Patients should be treated with kindness, respect, and dignity, and their privacy and confidentiality should also be respected – a locally determined ‘citizenship charter’ would tie health workers to this concept;

– Patients should be fully involved in decisions about their care, with an emphasis on supporting self-care, autonomy and health promotion;

– Who is responsible for each patient’s care on any given day, seven days a week, should be clear to the patient, their relatives and carers, and this team should be led by a named consultant working with a nurse ward manager;

– Patients should no longer be ‘discharged’ – planning for their future care needs and transfer to intermediate, community, primary, or social care, within a healthcare system, or their return home, should begin on admission;

– Patients should be assessed and diagnosed by a senior doctor on admission, and should see a specialist in their condition as soon as possible. This might mean seeing multiple specialists for some patients, with care coordinated by a single doctor;

– Acutely ill patients should have access to the same medical care at weekends as on weekdays;

– Continuity of care should be the norm, with an emphasis on excellent communication in relation to transferring the care of patients to new medical teams or new settings when their needs demand it.

Gain affordable Acute and Advanced General Medicine Training HERE.

Read all the key feedback to the report.

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2 Responses to “Medical wards have to be radically restructured”

  1. joshek says:

    one point is missing: unless the work conditions of the professionals in charge are not improving, they will continue to vote with their feet and the proposals on the table suggest the opposite. as usual, this aspect is completely ignored. with positions of chief of medicine and chief resident being created, the status of doctors will be fully americanised. that would be ok if the training is amercanised as well and bo over and done with, from fresh resident to attending physician in some 4 years. however, the current system that requires about a decade of training only to end up as a lowly minion to the chief of medicine is ridiculous.

  2. Life's more complex says:

    American system…requires American staffing levels, space and funding to work… blue sky thinking ….

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