Search

Background: This study describes the novel use of skin surface temperature to measure the severity and the response to treatment of skin and soft tissue infection (SSTI)., Methods: Patients admitted with SSTI for intravenous antibiotic therapy. Skin temperature was measured daily at the point of maximum heat on the SSTI affected limb and the non-affected limb using a non-contact laser thermometer., Findings: Sixty-three patients were included. Mean length of stay was 4.95 days. The difference between affected and unaffected limb was 3.5° C (95% CI 3.0-3.9) at day one and 2.1° C (95% CI 1.7-2.6) on the last day, a difference of 1.4° C (95% CI 0.7-1.9). Between day one and the last day, there was a significant reduction in affected limb temperature (mean reduction of 2.4° C, 95% CI 1.9-3.0 p<0.001)., Interpretation: Skin surface temperature may hold a useful role in the management of SSTI.

Introduction: Programs involving hospitals and general practitioners (GPs) have become more commonplace, with a greater emphasis on integration of health services emerging over the last generation. Hospital in the home (HIH) refers to the delivery of acute hospital services such as intravenous therapy, anticoagulation and wound care to patients in their own homes. This study sought to determine the extent to which HIH units had involved urban GPs, issues related to GP involvement, and the likely future of such involvement., Method: Telephone administered structured survey to all urban HIH coordinators/directors in Melbourne, Australia., Results: All 14 identified HIH coordinators were interviewed. Five units reported a direct role for GPs, six reported no role and three reported a limited role in managing intercurrent illnesses. Coordinators felt that variability of GP response and skills, GP availability and patient control were significant issues. An increase in future GP involvement was uncertain and conditional., Discussion: One-third of urban hospitals surveyed have involved GPs in their programs. However, issues such as variability in skills, enthusiasm and availability threaten expansion of such involvement. This calls for a review in the way GPs are involved in hospital programs, and for better relationships with hospital nursing staff. Limiting the number of involved GPs in any hospital-GP program may offer advantages to both groups. Despite the movement of hospital work into the community, GP involvement in such work is not guaranteed.

The authors review General Practitioners in Hospitals, a report prepared by the School of Medical Education, University of New South Wales (1993) for the Australian Health Ministers' Advisory Council Medical Workforce Group on Hospital Training and Career Development. The authors acknowledge that this report represents the most comprehensive look at GP involvement in hospitals across Australia, but suggest that its conclusion 'general practitioners play a substantial role in the provision of medical care in public hospitals around Australia' may be an overstatement. They discuss shortcomings associated with the study, including: definitional issues; variation in levels of involvement according to hospital type; potential biases introduced by using self-report of hospital administrators as the source of data; insufficient emphasis being placed on the views of GPs; and the validity of extrapolations.

This paper reviews the early challenges for Hospital in the Home units which choose to utilise general practitioner skills. A model is described. Issues surrounding GP selection, remuneration, responsibility, leadership, and other hurdles are described. Since alternatives to GP involvement exist, GPs should be prepared to seize this important opportunity.

Introduction: We sought to determine the impact of general practitioner communication on the efficient management of patients who present to the emergency department. Casemix, severity, time of presentation, the quality of the letter and the reception of a telephone call were considered., Method: All consecutive patients presenting to the emergency department of Mornington Peninsula Hospital (Frankston) for one month in 1992 were included in this survey. The methodology is summarised in Figure 1., Results: The referral letter made no difference to patients' waiting time and time spent in the department and a non significant difference in communication back to the general practitioner. This was found despite the quality of the referral letter, the time of presentation, and the diagnosis. The general practitioners' telephone call, however, decreased significantly the patient's waiting time. Investigations that were reported in the general practitioners' letters and not repeated by the emergency department resulted in a direct saving of $2604 for the month of the study. High interrater reliability was discovered in the rating of letters by six general practitioners., Discussion: Despite the ability of general practitioners to select appropriate cases for referral, only the telephone call results in a quantifiable benefit for patients who attend their general practitioner. The high inter-rater reliability affirms the use of referral letters as audit tools in general practice. Better practical use could be made of general practitioners' referral communication to the emergency department.

Objective: The Mornington Peninsula Hospital (MPH) in Victoria has a Division of General Practice whose members retain admission privileges. We will describe the use of general practitioner inpatient admitting rights at Mornington Peninsula Hospital., Method: The study will be a retrospective review of existing hospital databases., Results: From 1980 until July 1992 the rate of general practitioner admissions is decreasing at one per cent per annum. Comparative data shows an increase of 0.7 per cent in admissions per annum by medical specialists. Between 1988 and 1991 general practitioner admissions have been equally divided between obstetrics and general medicine. The proportion of long stay general practitioner inpatients is below one per cent of all general practitioner admissions, and the average length of stay for general practitioner inpatients approximates that of MPH in general. Most general practitioner inpatients are discharged home, and 3.1 per cent are transferred to other units or hospitals. Neoplastic disease accounts for 40 per cent of all the deaths within the general practitioner inpatient group., Discussion: This study shows that, in selected areas, the care of inpatients is still a valid role for some general practitioners.