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dc.contributor.authorKellett, John
dc.date.accessioned2012-01-26T11:26:21Z
dc.date.available2012-01-26T11:26:21Z
dc.date.issued2009-09
dc.identifier.citationHospital Medicine (Part 1): what is wrong with acute hospital care? 2009, 20 (5):462-4 Eur. J. Intern. Med.en
dc.identifier.issn1879-0828
dc.identifier.pmid19712844
dc.identifier.doi10.1016/j.ejim.2008.12.007
dc.identifier.urihttp://hdl.handle.net/10147/205033
dc.description.abstractModern 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.
dc.language.isoenen
dc.relation.urlhttp://www.sciencedirect.com/science/article/pii/S0953620508003476en
dc.subject.meshEmergency Service, Hospital
dc.subject.meshHealth Knowledge, Attitudes, Practice
dc.subject.meshHospital Mortality
dc.subject.meshHospitalization
dc.subject.meshHumans
dc.subject.meshOutcome and Process Assessment (Health Care)
dc.subject.meshTriage
dc.titleHospital Medicine (Part 1): what is wrong with acute hospital care?en
dc.typeArticleen
dc.contributor.departmentDepartment of Medicine, Nenagh Hospital, Nenagh, County Tipperary, Ireland. jgkellett@eircom.neten
dc.identifier.journalEuropean journal of internal medicineen
dc.description.provinceMunster
html.description.abstractModern 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.


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