title: The impact of consultant delivered service in emergency medicine: the Wrexham Model.
abstract: OBJECTIVE
  Consultant based delivery of emergency service is perceived to add value. This study aims to demonstrate the impact of such a service model based on consultant working in a UK emergency department.
  
  
  METHODS
  This retrospective study was based on the emergency department of a district general hospital. Activity data was analysed for 2009. Workload and admission rates were compared between consultants, middle grade doctors and senior house officers (SHOs). Admission rates were compared against two similar departments. Data from night shifts allowed consultant activity to be contrasted with middle grades and SHOs. Time spent in the department, admission rates, patients who left without treatment, discharged outright and clinic returns were used for comparison.
  
  
  RESULTS
  Consultants often saw more patients than SHOs or middle grade doctors. This was on top of their traditional duties of senior opinion. On comparison of activity at night shifts, they admitted fewer (25.2% vs 30.3%, p=0.026), had fewer leaving without treatment (1.6% vs 5.1%, p<0.001), discharged more outright (59.8% vs 47.5%, p<0.001), referred fewer to clinic (5.7% vs 6.6%, p=0.49) and had a faster turnaround time (p<0.001: Priority 2, 3 and 4) for every triage category. Some of the comparisons were clinically but not statistically significant.
  
  
  CONCLUSIONS
  A consultant based service delivery offers many advantages. These cannot be matched by either junior or middle grades. This would be in addition to the consultants' supervisory role. Consultant expansion is urgently required to achieve this sustainably. A further study evaluating the cost benefits of this service model is now underway.
authors.affiliation: Emergency Department, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK. thesens@msn.com
authors.forename: Aruni
authors.initials: A
authors.lastname: Sen
authors.forename: David
authors.initials: D
authors.lastname: Hill
authors.forename: Dilip
authors.initials: D
authors.lastname: Menon
authors.forename: Fiona
authors.initials: F
authors.lastname: Rae
authors.forename: Hywel
authors.initials: H
authors.lastname: Hughes
authors.forename: Robin
authors.initials: R
authors.lastname: Roop
mesh_terms: D003253:Consultants; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D017598:Efficiency, Organizational; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D017146:Models, Organizational; D012017:Referral and Consultation / Q000458:organization & administration; D012189:Retrospective Studies; D006113:United Kingdom; D016526:Workload