COPING WITH PRESSURES IN ACUTE MEDICINE - THE LEGE-OF-PHYSICIANS-CONSULTANT-QUESTIONNAIRE-SURVEY

Objectives: To assess the impact of reduced junior doctors' hours and increasing emergency admissions on patterns of acute medical care, and to evaluate recent innovations. Methods: Questionnaire survey of all 2,980 consultant physicians in England, Wales and Northern Ireland pot entially involved in acute medicine. The response rate was 63%, with 1 ,632 respondents undertaking unselected takes. Results: Workload - The median average number of admissions per 24 h was 20-24, but 25% of co nsultants admitted greater than or equal to 30. The median frequency o f take duties was 1 day in 5. Composition of resident medical teams - The most common permutation was one specialist registrar (SpR), senior house officer (SHO) and house physician (HP), coping with 20 admissio ns on average. However, the teams of 25% of respondents did not includ e a SpR, and 9% consisted solely of one SHO and one HP, with an averag e 17 admissions. Partial shift rotas - Forty-two per cent of consultan ts had introduced these. Most were critical of them because of their a dverse impact on continuity of care and junior staff training, and the ir unpopularity with trainees. Patterns of care - Only 10% of consulta nts indicated that myocardial infarction patients were managed exclusi vely by a cardiological team. Forty per cent operated an age-limit (va rying between 65 and 85) for admission under care of the elderly physi cians. Seventy per cent had introduced an admissions ward. New initiat ives to cope with admissions - These included twice-daily consultant t ake rounds, use of nurse practitioners and staff-grade doctors, 12-hou r takes and ward-based admission schemes. Measures to expedite dischar ges included 'discharge lounges', nurse facilitators, low-dependency w ards and 'hospital at home' schemes.