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Aspects of acute care which may be more fundamental than those elicited by the questionnaire of 12 acute care topics1 include criteria which enable healthcare workers (including junior doctors and nurses) to be more easily able to identify the seriously ill patient. This issue has been addressed by a study validating the use of a modified early warning score in medical admissions. The parameters evaluated in that study included blood pressure, pulse, respiratory rate, temperature, and conscious level, the latter simply characterised by documentation of alertness, reaction to vocal stimuli, reaction to pain, or absence of all three, as in the unconscious patient.2 In view of the proven efficacy of the scoring system utilised in that study, the “take away message” is that this is what juniors and nursing staff should be trained to evaluate, and it is the opportunity to instil these basic principles which should be optimised by promoting the ideal of teaching medical students and student nurses together at some stage in their respective training programmes. Furthermore, in order to maintain the momentum of shared educational objectives, doctors and nurses should utilise an integrated health record which should replace the present system of separate medical and nursing notes.
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