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Service development II
PTU-263 Is it time for gastroenterology and general medicine to go their separate ways?
  1. V Sehgal,
  2. B Krishnan,
  3. G McCulloch,
  4. K Besherdas
  1. Department of Gastroenterology, Chase Farm Hospital, London, UK

Abstract

Introduction Currently most gastroenterologists within the UK are general physicians with a specialist interest in gastroenterology (85%) and most gastroenterology (GI) trainees train for dual accreditation in GI and general internal medicine (GIM). They therefore commit a major part of their time to the management of patients with GIM problems as part of their unselected acute medical take and ward work. With the development of “acute medicine” as a specialty in its own right and the formation of specialty-based wards to care for medical in-patients it has been questioned whether gastroenterologists should train to obtain dual accreditation in GI and GIM. The increasing demands for provision of GI services further support the conflict of whether training in GIM is required. With this in mind, we aimed to assess patients admitted with a primary GI complaint that should be triaged to a GI ward, the number of acute (active) non-GI diagnoses requiring acute treatment and whether these were managed by gastroenterology or whether referral to a specialist team was made.

Methods A single centre, prospective analysis of all patients admitted with a primary GI diagnosis during the unselected general medical take over a 6-week period (November 2011–January 2012) was made. Chase Farm Hospital is a district general hospital that has a clinical decision unit, a short stay ward along with a speciality based ward triage for GIM patients. Data were obtained from medical notes and discharge summaries.

Results 62 patients (29 male, 33 female), median age 72.5 years were admitted over the study period. 38 patients (61.3%) had no other acute non-GI diagnoses requiring prompt treatment. 24 patients (38.7%) had at least one other non-GI diagnosis (range 1–2): 16 patients (25.8%) had one and eight patients (12.9%) had two active non-GI diagnosis. The most common non-GI diagnosis was cardiovascular in origin (9, 37.5%). Other non-GI diagnoses were respiratory (6, 25%), renal (6, 25%), endocrine (6, 25%), or other (4, 16.6%). Of these patients, 5 (20.8%) required referral to a specialist team for further investigation and/or treatment of their condition.

Conclusion A significant number of patients (∼39%) admitted as an acute medical emergency with a primary GI diagnosis have other active non-GI medical diagnoses. The majority of these were managed by gastroenterology and only in one in five patients was a specilaist opinion sort for further management. By training and maintaining skills in GIM, gastroenterologists are more able to independently manage acute medical patients admitted with a primary GI diagnosis and avoid inter-specialty referral in up to 25% of patients. From this study we support the dual accreditation sought by gastroenterology trainees in GIM.

Competing interests None declared.

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