Improving quality measures in the emergency services

A large and continuing increase in medical emergency admissions has coincid ed with a reduction in hospital beds, putting the acute medical services un der great pressure. Increasing specialization among physicians creates a co nflict between the need to cover acute unselected medical emergencies and t he pressure to offer specialist care. The shortage of trained nursing staff and changes in the training of junior doctors and the fall in their workin g hours contribute to the changing role of the consultant physician. The organization of the acute medical service is of paramount importance an d requires multi-disciplinary teamwork on an admissions unit with full supp ort services. Excellent bed management is essential, There must be guidelin es for all the common medical emergencies and all units must undertake spec ific audits of the acute medical service. Continuing professional developme nt (CPD) and continuing medical education (CME) should reflect the workload of the physician; that is, it must include time specifically focused on ac ute medicine and general (internal) medicine, as well as the specialty inte rest.