title: Can additional experienced staff reduce emergency medical admissions?
abstract: 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.
authors.affiliation: Accident and Emergency Department, Northern General Hospital, Sheffield, UK. s.goodacre@sheffield.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Goodacre
authors.forename: S
authors.initials: S
authors.lastname: Mason
authors.forename: R
authors.initials: R
authors.lastname: Kersh
authors.forename: A
authors.initials: A
authors.lastname: Webster
authors.forename: N
authors.initials: N
authors.lastname: Samaniego
authors.forename: F
authors.initials: F
authors.lastname: Morris
mesh_terms: 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