Acute Care

Acute care encompasses the rapid assessment, stabilisation and treatment of patients with sudden or severe health problems across multiple settings—from the prehospital environment and emergency department to intensive care units and observation wards. The primary goals are to secure vital functions, establish a working diagnosis and initiate time-sensitive therapies such as thrombolysis, mechanical ventilation or fluid resuscitation. Coordination among paramedics, emergency physicians, nurses and allied professionals underpins this high-pressure workflow. Recent years have seen growth in alternative acute-care models—such as Hospital-at-Home and telemedicine support for remote or under-resourced units—that aim to deliver hospital-level interventions outside the traditional ward. Early recognition of deterioration, judicious use of diagnostics, antibiotic and VTE prophylaxis stewardship, and structured discharge planning are essential to mitigate in-hospital complications and readmissions. As populations age and comorbidity burdens rise, acute care faces mounting demands for speed, safety and continuity, driving innovation in environment design, digital monitoring and personalised mobilisation strategies.

Research from Nature Portfolio

Analysis of national healthcare billing data revealed an immediate, broad-based decline in non-COVID hospitalisations across 19 diagnostic categories during the first pandemic year, with many inpatient services failing to return to pre-pandemic levels for over eighteen months, underscoring shifts in acute-care utilisation and the need for adaptable surge capacity. A large observational study of over 200 000 Spanish inpatients demonstrated marked deterioration in sleep quality after admission, linked to environmental factors and care routines; scores on the Pittsburgh Sleep Quality Index increased substantially in hospital, highlighting an unmet need for systematic sleep preservation protocols in acute wards. In Brazilian intensive care units, high-dimensional analyses showed that each percentage increase in COVID-19 occupancy correlated with a 1.3-point rise in mortality risk among non-COVID patients, quantifying the spillover effect of pandemic pressures on overall acute-care outcomes.

Research from all publishers

A participatory design project rebuilt two intensive-care bedspaces using sound-absorbing materials, programmable lighting and immersive digital nature views; early evaluation indicated reduced noise peaks and more natural light cycles, with trends towards fewer nocturnal awakenings and improved subjective rest, offering a scalable model for ICU refurbishment. Deep-learning models trained on sequences of five vital signs and a composite early-warning score accurately identified low-risk patient-nights, safely deferring half of non-critical overnight checks and minimising sleep interruptions without compromising safety. In emergency medicine, a mixed-methods feasibility trial of evening mobilisation sessions between 19:00 and 21:00 in mechanically ventilated patients reported high consent and retention, strong acceptability and preliminary reductions in the incidence and duration of delirium, laying the groundwork for larger studies on strategic timing of rehabilitation in the ICU.

Acute Care publication trend

The graph below shows the total number of articles in acute care across all publications each year (not limited to Nature Index journals).

Technical terms

Intensive Care Unit (ICU): A specialised hospital unit providing around-the-clock monitoring and organ support for critically ill patients.

Hospital-at-Home: A care model delivering hospital-equivalent acute interventions in the patient’s residence, including intravenous therapies and nursing visits.

Early mobilisation: Initiation of physical activity—ranging from passive movements to ambulation—within 48–72 hours of ICU admission to reduce muscle deconditioning and delirium.

Antibiotic stewardship: Coordinated interventions to optimise antibiotic prescribing, duration and selection, thereby reducing resistance and adverse events.

Venous thromboembolism (VTE) prophylaxis: Preventive measures, both mechanical (e.g., compression devices) and pharmacological, to avert deep vein thrombosis and pulmonary embolism in immobile patients.

Triage: The process of promptly assessing patient urgency and directing them to the appropriate level of care using standardised scoring systems.

References

1. Trends in non-COVID-19 hospitalizations prior to and during the COVID-19 pandemic period, United States, 2017–2021. Nature Communications (2022).
2. Sleep quality among inpatients of Spanish public hospitals. Scientific Reports (2022).
3. Big data evidence of the impact of COVID-19 hospitalizations on mortality rates of non-COVID-19 critically ill patients. Scientific Reports (2023).
4. Creating the ICU of the future: patient-centred design to optimise recovery. Critical Care (2023).
5. Let Sleeping Patients Lie, avoiding unnecessary overnight vitals monitoring using a clinically based deep-learning model. npj Digital Medicine (2020).
6. Mobilisation in the EveNing to prevent and TreAt deLirium (MENTAL): a mixed-methods, randomised controlled feasibility trial. EClinicalMedicine (2023).
7. Acute Care in the Home Setting: Hospital at Home.