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Hospital Medicine (Part 1): what is wrong with acute hospital care?
Kellett, John
Kellett, John
Author
Advisors
Editors
Other Contributors
Date
2009-09
Date Submitted
Keywords
Other Subjects
Subject Mesh
Emergency Service, Hospital
Health Knowledge, Attitudes, Practice
Hospital Mortality
Hospitalization
Humans
Outcome and Process Assessment (Health Care)
Triage
Health Knowledge, Attitudes, Practice
Hospital Mortality
Hospitalization
Humans
Outcome and Process Assessment (Health Care)
Triage
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
Abstract
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.
Language
en
ISSN
1879-0828
eISSN
ISBN
DOI
10.1016/j.ejim.2008.12.007
PMID
19712844