Description of specialty

Introduction

Acute internal medicine (AIM) was formally recognised as a specialty for medical training in August 2009. It is defined as,‘that part of general internal medicine (GIM) concerned with the immediate and early specialist management of adult patients suffering from a wide range of medical conditions who present to, or from within, hospitals, requiring urgent or emergency care’.

AIM differs from most other medical specialties as it is not based around a body system, such as cardiology and the heart, or a disease, such as stroke. Most patients presenting with an acute medical illness describe symptoms or signs requiring a diagnosis, for example chest pain, or confusion and falls in older people. In some cases the diagnosis is immediately clear, for example deliberate self-harm. Many patients are physiologically unstable and require resuscitative measures, while other patients are well but require urgent diagnostic investigations. In older patients especially, an important consideration is the interaction of an acute illness and social care needs. The challenge for AIM is to provide a range of high-quality services to a heterogeneous group of patients.

The key features of AIM are:

  • clinical service delivered by consultant physicians for at least 12 hours per day
  • clinical service delivered by consultant physicians 7 days per week
  • service designed and managed by consultant acute physicians specialising in AIM
  • service delivered by a specialist and dedicated multidisciplinary team
  • the acute medical unit (AMU)
  • service design informed by quality standards
  • managing patients for up to 72 hours after presentation
  • performance benchmarked against key clinical quality indicators for AMU
  • access to rapid assessment and diagnostics
  • providing joined-up health and social care to facilitate early, safe discharge when appropriate
  • signposting healthcare providers and patients to a more appropriate and alternative service when required, for example a rapid access chest pain clinic or first fit clinic.

How acute internal medicine evolved

The requirement for a specialty to deliver the care traditionally provided by general internal medicine (GIM) emerged over 20 years ago. AIM subsumed the clinical skills associated with GIM but with an emphasis on the organisation and delivery of acute medical care by consultant physicians. The established model of patients coming to the emergency department for admission to a ward bed was unsustainable in the face of reduced bed capacity and increasing numbers of patients. Alternative models of care were required. AIM evolved to provide patients with the best quality care and in the right environment, with assessment, diagnosis and treatment as actively managed processes.