Hospital Medicine (Part 1): what is wrong with acute hospital care?
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Authors
Kellett, JohnAffiliation
Department of Medicine, Nenagh Hospital, Nenagh, County Tipperary, Ireland. jgkellett@eircom.netIssue Date
2009-09MeSH
Emergency Service, HospitalHealth Knowledge, Attitudes, Practice
Hospital Mortality
Hospitalization
Humans
Outcome and Process Assessment (Health Care)
Triage
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Hospital Medicine (Part 1): what is wrong with acute hospital care? 2009, 20 (5):462-4 Eur. J. Intern. Med.Journal
European journal of internal medicineDOI
10.1016/j.ejim.2008.12.007PubMed ID
19712844Additional Links
http://www.sciencedirect.com/science/article/pii/S0953620508003476Abstract
Modern hospitals are facing several challenges and, over the last decade in particular, many of these institutions have become dysfunctional. Paradoxically as medicine has become more successful the demand for acute hospital care has increased, yet there is no consensus on what conditions or complaints require hospital admission and there is wide variation in the mortality rates, length of stay and possibly standards of care between different units. Most acutely ill patients are elderly and instead of one straightforward diagnosis are more likely to have a complex combination of multiple co-morbid conditions. Any elderly patient admitted to hospital is at considerable risk which must be balanced against the possible benefits. Although most of the patients in hospital die from only approximately ten diagnoses, obvious life saving treatment is often delayed by a junior doctor in-training first performing an exhaustive complete history and physical, and then ordering a number of investigations before consulting a senior colleague. Following this traditional hierarchy delays care with several "futile cycles" of clinical activity thoughtlessly directed at the patient without any benefit being delivered. If acute hospital medicine is to be improved changes in traditional assumptions, attitudes, beliefs and practices are needed.Item Type
ArticleLanguage
enISSN
1879-0828ae974a485f413a2113503eed53cd6c53
10.1016/j.ejim.2008.12.007