Curriculum for General Practice - The Royal New Zealand College ...

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Acute Care
Acute Care
Acute care is, broadly speaking, managing
illness or accidents in patients who present
acutely, i.e. unscheduled, in a practice or in
the community. There may be considerable
discordance between a doctor’s view of what
is an acute problem and a patient’s view, and
there may be many other factors affecting the
manner and timing of presentation.
Managing acute presentations may be challenging,
satisfying, disruptive, frustrating or even frightening, but
it is part of general practice and good patient care. The
immediate care of people suffering in these conditions
is paramount to their long-term health outcome.
How much acute care a GP has to do will depend on
the practice’s location in terms of distance and time from
an emergency department. Also impacting on the type
and frequency of the acute care is the practice
demographics. Māori, Pacific and some rural patients
will tend to present with more serious and advanced illness
than other New Zealanders. 1,2 The organisation of the
practice may allow for acute presentations, for example it
may have nurse or doctor appointments kept open for acute
presentations and/or it may have an after-hours arrangement.
In rural areas, acute care is a far more significant part of
the general practitioner’s daily work, with the rural practice
and/or community hospital acting as the emergency
department. The doctor on duty must be prepared to
manage any patient who walks, or is carried, through the
door, or who they are called to urgently. This requirement is
one of the defining features of rural medicine and can seem
daunting or overwhelming.
General practitioners need to cope with a variety of traumatic
and medical emergencies, as well as acute minor trauma.
Life-threatening emergencies will require hospital intervention
and general practitioners require the knowledge and triage
skills to choose the appropriate management.
There are now initiatives in some urban areas of
New Zealand that allow more advanced investigation,
management and observation of patients in primary care
urgent and after-hours centres to reduce pressure on
overcrowded emergency departments. These initiatives
allow general practitioners the challenge and satisfaction
of managing acutely ill patients, and help to provide a more
patient-centred model of care. 3
1
Craig E, McDonald G, Adams J, Reddington A, Oben G, Simpson J, Wicken A. 2012. Te Ohonga Ake 1: The Health of Māori Children and Young People with Chronic
Conditions and Disabilities in New Zealand. New Zealand Child and Youth Epidemiology Service: Dunedin.
2
Baker MG, Barnard LT, Kvalsvig A, Verrall A, Zhang J, Keall M, Wilson N, Wall T, Howden-Chapman P. 2012. Increasing incidence of serious infectious diseases and
inequalities in New Zealand: a national epidemiological study. Lancet; 379:1112-9.
3
Ardagh M. 2010. How to achieve New Zealand’s shorter stays in emergency departments health target. Journal of the NZ Medical Association.
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Curriculum for General Practice