Perils, Pitfalls and Solutions
in Acute Medicine
Dr Martin Pattrick
Consultant in Acute Medicine
Background
Being a Doctor wasn’t my first
choice of career
My credentials
 Been around a long time !
 Experience with various types
of hospitals
Experience……………
…is what you get when you’re
looking for something else.
Experience
3 Hospitals:
• Pennine Acute Hospitals NHS Trust –
North Manchester General site
• University Hospital of South Manchester
(UHSM)
• Tameside General Hospital
Main problem
Protecting the site at night
Some suggestions
Local workforce pressures
1. Nurse recruitment
2.Doctor recruitment
Solve these and there’s
usually no other
recruitment problems
Nurse recruitment
 Mainly working conditions
 Physical
 Low absence / sickness
vacancies
 Training – an important aspect
Doctor Recruitment
 Supportive environment
 Office space !
 Camaraderie
Advanced Nurse Practitioners
–Not cheap
–Can be extremely effective
–Develop protocols
–Organise themselves
Band 3 / 4 – HCAs / APs
– Great help with ward rounds
– Results retrieval
– Bloods, cannulas, ECGs
– Handover facilitation
Pharmacy
– Train to prescribe
– TTOs
– Use in PTWR
– Discharge summaries in the morning
– Early discharge
Ambulatory Care
If you have one strategy to
survive winter…..
choose this!
Ambulatory Care
• If it walks… put it in ambulatory care
• It’s not about closing beds, it’s about
making beds work harder
• Income generation
Concept of urgent care
– End dichotomy of MAU / ED
– Involve the surgeons
– Close working relationships
– Joint meetings
Usual System
Patient
A&E
Trainee
A&E
Senior
Medical
Trainee
Medical
Senior
Emergency Dept in-reach
Patient
A&E Trainee
Acute Medical
Consultant
OR
Patient
Acute Medical
Consultant
Top Tips
– Get a clinical champion but don’t pay
extra!
– Arrange for” boots on the ground”
– Get ambulatory care up and running
efficiently
Questions ?
Thank You