Patients with an acute medical condition will usually access AIM services via a referral from their GP or self-attend the emergency department. Less commonly, patients will be referred from within the hospital, either from an outpatient clinic or another inpatient specialty. Rarely, patients are transferred from another hospital or repatriated from abroad. The pathways to access and exit acute medical care are schematically represented in Fig 1.
Figure 1. Pathways to access acute internal medicine
In well-developed units, GP calls are taken by a consultant acute physician who can triage the patient to the right service, to avoid all patients coming to the emergency department or AMU. Alternative care pathways include ambulatory emergency care (AEC), telephone advice or urgent access to a specialty clinic.
Not all patients with an acute medical condition access acute hospital services via AIM. In certain situations patients will be sent directly from the emergency department to a specialty, for example patients with an ST-segment-elevation myocardial infarction will be sent to cardiology, or patients with a stroke to an acute stroke unit. Direct referrals to a specialty might require transfer to a tertiary centre in another hospital.
How patients access acute medical care varies from hospital to hospital, depending on the local availability of co-located specialty services.