The undivided patient: a retrospective cohort analysis of specialty referrals made from inpatient general medical units comparing regional to metropolitan practice.

BACKGROUND: In an era of growing subspecialisation there has been significant research into the role, determinants and outcomes of outpatient referrals but very little on inpatient specialty referrals from general medical units. AIMS: This study aims to describe and compare the rate of specialty referrals from inpatient general medical units in a regional general and a metropolitan tertiary hospital, and review associated outcomes. METHODS: Retrospective cohort analysis of general medical admissions over the 10-week period extending from 28 March to 5 June 2011. Two hospitals were included in the study; West Gippsland Hospital (WGH) and Monash Medical Centre (MMC). For all admissions, details of patient demographics, episode of care and number of inpatient referrals made per admission were extracted from the medical records. Rates and outcomes of inpatient referrals were calculated and compared. RESULTS: There were 116 admissions to MMC and 108 (107 available for analysis) to WGH during the study period. There were no significant differences in patient demographics between the two sites. However, there were significantly fewer active conditions (2.87 vs 4.01, P < 0.01), fewer specialty fields represented (2.50 vs 3.51, P < 0.01) and fewer specialty referrals made per admission at WGH compared with MMC (0.69 vs 1.74, P < 0.01). The referral rate per diagnosis and the rate of referrals per specialty field represented were significantly higher at MMC compared with WGH (P < 0.01). CONCLUSION: This preliminary study suggests that patients admitted to rural hospital general medical units have fewer active conditions with fewer specialty referrals made per admission, compared with a comparator metropolitan hospital general medical unit. Further research is required to investigate the reasons for such differences and implications for policy and practice.

Improving the implementation of community-acquired pneumonia guidelines.

Best practice guidelines define the essential elements of care. They can improve the treatment of patients with community-acquired pneumonia (CAP). Although guidelines advocating these elements are readily avail-able, the care received by patients with CAP remains heterogeneous. In the present report, the use of a -computer-based assistant to decision-making was -successfully developed and tested, improving the application of well-known guidelines.

Emergency treatment of severe hypertension with intravenous labetalol.

The effects of intravenously administered labetalol on blood pressure and pulse rate were examined in 17 patients with severe hypertension. Prompt and sustained falls in supine blood pressure and pulse rate occurred in ten patients (responders), but seven patients showed little or no change in either measurement (non-responders). Labetalol had a more marked effect on standing than on supine blood pressure. Only two of the responders, but all of the non-responders were concurrently receiving antihypertensive drugs. Plasma renin activity, plasma renin concentration and plasma angiotensin II concentration fell slightly over the one-hour period of observation in ten patients in whom serial measurements were made, but the changes were independent of the blood pressure response.