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    Hospital Medicine (Part 1): what is wrong with acute hospital care?

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    Authors
    Kellett, John
    Affiliation
    Department of Medicine, Nenagh Hospital, Nenagh, County Tipperary, Ireland. jgkellett@eircom.net
    Issue Date
    2009-09
    MeSH
    Emergency Service, Hospital
    Health Knowledge, Attitudes, Practice
    Hospital Mortality
    Hospitalization
    Humans
    Outcome and Process Assessment (Health Care)
    Triage
    
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    Citation
    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 medicine
    URI
    http://hdl.handle.net/10147/205033
    DOI
    10.1016/j.ejim.2008.12.007
    PubMed ID
    19712844
    Additional Links
    http://www.sciencedirect.com/science/article/pii/S0953620508003476
    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.
    Item Type
    Article
    Language
    en
    ISSN
    1879-0828
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ejim.2008.12.007
    Scopus Count
    Collections
    Nenagh General Hospital

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