A new survey from the Royal College of Physicians (RCP) recommends that hospitals need to increase the availability of senior doctors in acute admissions units, particularly at weekends.
Care for very ill patients has improved significantly over the past few years due both to the introduction of acute medical admissions units in most major hospitals, and a major increase in the number of consultant physicians specialising in acute medicine to assist other hospital specialists working in acute medical admission units. However, the RCP reports that, despite these changes, many patients are only seen once per day in a formal ward round instead of the recommended two daily ward rounds. In three quarters of the acute medical admissions units accepting patients directly from GPs, the unit runs out of beds. Furthermore, nearly half (48%) of consultant physicians responsible for assessing and treating patients on their arrival at the acute medicine ward (the “acute take”) still have to do routine clinics or other parts of their job as well as at the same time seeing the urgent patients. The survey also found that only 3% of hospitals provided weekend cover from consultant physicians specialising in acute medicine for 9 to 12 hours and none for over 12 hours. Nearly three-quarters of hospitals in the survey had no cover from consultant physicians specialising in acute medicine over the weekend. Previous studies have shown that a consultant-delivered service is best for patient treatment and recovery. Sir Richard Thompson, president of the Royal College of Physicians, said that patients deserve better care in hospitals in the evenings and at weekends, and commented: “Too many junior doctors are covering too many very ill patients, and this has to change.” Introducing a new statement produced by the RCP’s Council on doctors working hours, he said that many hospitals did not have enough senior doctors present to care for patients out of hours and at weekends, and that new working patterns would be needed in future. The RCP is concerned with the mounting evidence of poor care delivered to patients in hospital, and has recommended for the first time that any hospital admitting acutely ill patients should have a consultant physician on-site for at least 12 hours per day, seven days a week, who should have no other duties scheduled during this time. All medical wards should have a daily visit from a consultant; in most hospitals this will involve more than one physician.
