Editorial – Evolve, Adapt, Innovate and Deliver: Acute Medicine post COVID pandemic
Authors:   Consultant in Acute Medicine, University College London Hospitals, London, Lovell Ben 
Published: July 2021

Predictions for acute care in the upcoming months are difficult. There will be challenges: there always are and that to a degree is what makes working in acute care so fulfilling. However, even the most adaptive and innovative acute care systems will toil when these challenges become overwhelming. Back in 2015, the then SAM President Mark Holland described a “perfect storm” of events that could lead to a challenging winter period. It was as predicted; but this storm continues to evolve and has not yet reached its perfected chaotic peak. A picture of the COVID pandemic without the brilliant and innovative work of Acute Medicine teams is even darker. As a specialty we should and must remain proud of the impact we are having in delivering safe and sustainable care despite immense pressures. There is an escalating sense of desperation to reach a post-pandemic phase. Increasingly the sense of community unity and spirit at the beginning of the pandemic is being replaced by fear and disgruntlement. A toxic mix of emotions permeates and increasingly hostile divisions as to how manage the next stage of the pandemic grow. Opposing viewpoints are entrenched and neither wants to countenance a brief reflection on any deviation from their position. Meanwhile many people simply observe with bafflement and a sense of betrayal desperate for their lives to return to “normal”. Delivering acute medical care on this background is a challenge that none of us have faced. The skills and resilience of our teams will face its sternest test yet. As a specialty we will continue to do what we have always done since its inception: evolve, adapt, innovate and deliver. This issue of the journal reflects the fantastic work in Acute Medicine that continues to be delivered internationally despite the current challenges. Chris Subbe and the SAM Quality Improvement team have written a review considering frameworks for measuring quality in Acute Medicine.1 Quantifying the impact that Acute Medicine has on the patient journey with defined measurable metrics is key to embedding high quality acute care. The recognition and evaluation of abnormal physiology remains core to the practice of Acute Medicine. International Acute Medicine colleagues from Denmark and Hong Kong present some innovative work on the potential use of thermography in predicting prognosis in acute care.2 In a prospective study of 726 patients they demonstrated that the temperature gradient between nose and eye could help identify variations in skin perfusion and was predictive of all cause 30 day mortality.3 This requires further study but may become a further useful tool in the assessment of physiology of acute unwell medical patients. Dutch colleagues prospectively studied 1328 patients presenting acutely with infective illnesses. Their results reaffirmed the superiority of NEWS to SIRS and qSOFA in predicting mortality and outcomes in this cohort.4 The evolving nature and clinical characteristics of COVID19 are described by Cat Atkin and her colleagues from Birmingham.5 This important paper provides robust data on which to benchmark the severity of future variants of the virus and can support complex service provision planning adapted to the pandemic. Once again, SAM and the editorial board of Acute Medicine thank all colleagues for their amazing and diligent work during the pandemic, which we know will continue long after it. We hope that all friends and colleagues are able to have some well deserved rest and relaxation during a summer break.