4. Look at the pictures, showing a journey through a&e (Accident and Emergency). What happens at each stage?

5.Read Part 1 of the lecture. A. What is the lecturer going to talk about today? - emergency care - palliative care - patient journey - problems in provision of hospital care - primary care B. What is acute care?

Part 1 - Good morning everyone. What I’m going to talk about today is the medical treatment and care provided through our hospitals. Bearing in mind that hospital care comes in various different forms. The area of care that we are specifically going to focus on today is emergency care, which is also known as acute care. What I mean is the treatment of a disease or symptom that require immediate attention; the care generally received by patients in Accident & Emergency. Today we’ll simply deal only with the provision of acute emergency care and the problems facing acute hospitals today.

Part 2. C. Roughly what percentage of patients enters hospital for emergency treatment? What is specific about doctors working in acute care departments? Give some examples.

As you already know, just over half of those entering a UK hospital on any given day are admitted in emergency circumstances as opposed to by appointment (in other words treatment that has been planned in advance). The emergency department encompasses all fields of medicine and surgery, and is responsible for patient admission, initial diagnosis and treatment. Medical practitioners working in emergency medicine possess a broad filed of knowledge and procedural skills, including trauma resuscitation and surgical procedures, as well as advanced cardiac life support, etc. in other words, the average emergency doctor requires the skills of several different specialists at once; whether it be plastic surgery, to stitch complex lacerations, orthopedics, for setting fractures, or simply ear nose and throat to stop a nose bleed. Not to mention gynecology and cardiology. Indeed, h or she is required to deal with patients of all age groups and with the full spectrum of physical and behavioral disorders.

D. Match each fixed phrase in the table with the type of information that can follow.

E. Read Part 3 of the lecture. - Make note after each phrase in D.

Now, an important concept in the smooth running of any hospital and one which frequently raises concern in the popular press in is the notion of Integrated Care Pathway or ICP. O, what do I mean by Integrated Care Pathway exactly?

Well, to help you understand this concept, can you look for a moment at the patient leaflet that I have just handed out? As you can see, a patient typically arrives in admissions and then passes through several departments meeting different members of the emergency team before being discharged at the end of his or her stay.

Let’s look at an example of this. Say a patient arrives with a suspected fracture hip. After being admitted, the patient may spend time in the waiting room before being sent by the triage nurse who will assess their symptoms and vital signs. They will be then be sent for an x-ray before going to the Surgical Assessment Unit. Just prior to the operation the anesthetist will make an assessment of the patient’s fitness for operation.

Immediately after the operation the patient will spend time in the recovery room, then go back to the orthopedic ward. And then, finally, the patient is discharged back to the care of their GP or family doctor. Despite significant advances in technology and increased specialization, the organization of these departments has changes very little. However, looking at it another way, changes in the patient mix and profile, an ageing population in effect, has brought about certain problems, notably an increase in admissions to acute care hospitals. And that’s for both emergency and planned care. The point is that the resulting flow of patients is often inefficient and poorly coordinated. This is a phenomenon that has been noted in small regional hospitals as well as the larger teaching hospitals/ in financed terms, hospital wards are under pressure to close and the number of beds to be reduced. But why is ‘patient flow’ so important? Well, with hospitals that are capable of functioning to their optimal capacity, patient waiting times are reduced, the quality of care is improved and hospitals become more cost-effective; in this way maximizing the benefits of hospital care for all those who need it.

SURGICAL TREATMENT.

A. The operating theatre.

Surgery is carried out in an operating theatre. Great care is taken to make sure that operations take place in sterile conditions – free from microorganisms. The surgeon and his or her assistant wash or scrub up, and put on surgical gowns, masks, and gloves. The patient’s skin is prepared by disinfecting it with an antiseptic solution. This is known as prepping (preparing) the patient. They are then covered with sterile drapes, so that the only area of the operation is exposed.

B. Instruments.

С. The operation.

The operation begins when the surgeon makes an incision or cut. Control of bleeding is very important. A swab is a pad of cotton or other material use to soak up blood from the operation site. A sucker is a mechanical device which aspirates blood. Bleeding vessels are tied with ligatures or sealed by an electric current (diathermy).

Drains may be inserted to carry away fluid which might act as a culture medium for bacteria. Various methods are used to close the wound, for example sutures (also known as stitches), or staples. Finally, the wound is covered with a dressing.

D. An operation report.