Can additional experienced staff reduce emergency medical admissions?
BACKGROUND
Increases in emergency medical admissions are placing a strain upon hospitals throughout the world. The aim of the study was to evaluate the effect of a new post, the "A&E physician", upon emergency medical admissions to a hospital.


METHODS
For six months the A&E physician workload was audited and a randomised controlled comparison undertaken. Days were randomised to "A&E physician present" or "A&E physician absent". The A&E physician recorded details of all patients referred for medical admission, any intervention made, and their disposal from A&E. Routine hospital data compared the mean daily number of medical admissions, non-medical admissions, and referrals to other hospitals.


RESULTS
124 days were randomised: 59 to A&E physician present, 65 to A&E physician absent. The A&E physician received 581 referrals and intervened in the management of 142 (24%). Of these, 80 were discharged home, apparently saving 1.4 admissions per day. However, randomised comparison showed that presence of the A&E physician was associated with a reduction of only 0.7 medical admissions per day (95% CI -1.7 to 3.2, p = 0.561), and an increase of 1.1 non-medical admissions (95% CI -0.2 to 2.3, p = 0.09) and 0.3 transfers to other hospitals per day (95% CI zero to 0.6, p = 0.09). Overall, hospital admissions were increased by 0.9 per day when the A&E physician was present (95% CI -1.8 to 3.6, p = 0.5).


CONCLUSIONS
Despite receiving many referrals and discharging a substantial proportion of these patients home, the A&E physician did not significantly change emergency medical admissions and may have increased admissions to other specialties.
Goodacre
S
S
Accident and Emergency Department, Northern General Hospital, Sheffield, UK. s.goodacre@sheffield.ac.uk
Mason
S
S
Kersh
R
R
Webster
A
A
Samaniego
N
N
Morris
F
F
D004630:Emergencies; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004635:Emergency Medicine; D006760:Hospitalization; D006801:Humans; D008505:Medical Staff, Hospital; D006113:United Kingdom; D000078329:Workforce; D016526:Workload