This survey has demonstrated that the use of telemedicine in the management of hyperthyroidism is desirable to a majority of patients, as long as adequate time slots are dedicated to the telemedicine sessions and patients are reassured of the availability of face-toface consultation sessions. Regular patient feedback is necessary to perfect the use of telemedicine in a patient-centered healthcare service.

A patient’s first encounter with a consultant clinician, known as the post-take ward round (PTWR), is a pivotal encounter at the start of their hospital journey. It is a chance for a review of history, examination and investigations, formulation of preliminary diagnosis and management plan. High-quality patient care is reliant on effective communication of clinical information between teams, and the PTWR record is an integral part of this handover of information across different clinicians, medical teams and wards.Consensus of consultant opinion allowed for the formation of a standard against which the quality of PTWR documentation could be measured. This project aimed to assess and improve compliance with the devised standard.Following a survey of referrals made to the medical team after the move to electronic record keeping, it was found that important information was being missed from PTWR records. For example, of the 446 records analysed, only 34% had a documented potential discharge date (PDD) and 20% had a documented escalation plan. Analysis showed overall compliance to core criteria was 63%.Several changes within the department of acute medicine were trialled, including the introduction of a checklist, prompt cards for clinical staff to carry and finally the implementation of an electronic form for PTWR records.Over the course of several cycles of data collection, compliance with core criteria improved from 63% to 86%. Most notably, improvement was seen in documentation of social history (42%–87%), frailty score (0%–63%), PDD (41%–81%) and escalation plan (21%–66%).This work demonstrates the value of development of a standard for PTWR documentation, and of a proforma. The actions taken in this hospital may be of benefit to other medical departments.

Water intoxication is a life-threatening disorder accompanied by brain function impairment due to severe dilutional hyponatremia. We present a young woman who had multiple emergency admissions with severe dyselectrolytemias involving several electrolytes. Further assessment revealed a long history of chronic polydipsia and episodic water intoxication. Her serum electrolytes were normal after an overnight fluid fast. She had no further admissions after discussion and counseling concerning excessive water drinking. This case emphasizes the importance of obtaining an accurate fluid intake history in cases of hyponatremia and multiple electrolyte disturbances.

Robertson et al. describe the impact of a novel educational intervention, aiming to empower medical students to undertake quality improvement (QI) projects. 1 Whilst highly welcome, a vital element that should be central to all QI teaching went unmentioned: environmental sustainability.