title: Impact of senior clinical review on patient disposition from the emergency department.
abstract: BACKGROUND
  The delivery of high quality emergency medicine ideally involves input from senior doctors 24 h a day. This study aims to assess the influence of 'real-time' senior clinician supervision on patient disposition from a UK emergency department.
  
  
  METHODS
  The study was set in a UK teaching hospital with 24 h senior cover. Patients were initially seen by a junior doctor who completed a plan for the patient before seeking senior advice. Primary outcome measures were a change in patient outcome of discharge, admit, telephone speciality for opinion or outpatient follow-up.
  
  
  RESULTS
  556 patients underwent senior review during the study period. Review reduced inpatient admissions by 11.9% (95% CI 7.2% to 18.2%) and specifically reduced admissions to the acute medical assessment unit by 21.2% (95% CI 13.5% to 30.8%). Inappropriate discharge was prevented in 9.4% (95% CI 6.2% to 13.7%) and appropriate use of outpatient facilities resulted in a rise of 34.6% in appointments.
  
  
  CONCLUSIONS
  Senior doctor input in patient care in the ED adds accuracy to disposition decisions, impacting on patient safety and improving departmental flow.
authors.affiliation: Emergency Department, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. awhite4@nhs.net
authors.forename: Alison L
authors.initials: AL
authors.lastname: White
authors.forename: Peter A R
authors.initials: PA
authors.lastname: Armstrong
authors.forename: Shobhan
authors.initials: S
authors.lastname: Thakore
mesh_terms: D054869:Clinical Audit; D004636:Emergency Service, Hospital / Q000592:standards*; D006784:Hospitals, Teaching; D006801:Humans; D008505:Medical Staff, Hospital / Q000592:standards*; D010351:Patient Discharge; D017064:Process Assessment, Health Care / Q000379:methods*; D006113:United Kingdom