The critical care/acute medicine interphase

A significant number of medical admissions and inpatients on general wards are unstable or have unmet medical or nursing needs. Ward-based physiological scoring (early warning scores) and similar innovations aim to identify those who may merit enhanced care, and initiatives such as 'comprehensive critical care' describe a whole system approach to this group. While the recommendations in this 15-year-old document have been largely accepted and implemented, the Future Hospital Report recognises that close cooperation between acute medicine and critical care is essential but lacking in many institutions. Much of what follows is opinion and conjecture as there is little hard data to refer to. Although an anaesthetically trained intensivist, I have been a member of the Society for Acute Medicine since its inception and have sat on Council since then as critical care representative. I was also the clinical director for acute medicine in Norwich for three years.