title: Consultant volume, as an outcome determinant, in emergency medical admissions.
abstract: BACKGROUND
  Increasing hospital or specialist volumes has been shown to improve outcomes; there are little data on volumes and outcomes in emergency medical admissions. We have examined the hospital length of stay (LOS) and 30-day mortality for patients admitted under a consultant 'of the day' having high- or low-admission volumes.
  
  
  METHODS
  An analysis was performed on all emergency medical patients admitted between 1 January 2002 and 31 December 2011, using anonymous patient data. We calculated the numbers of unique patients admitted to each 'on call' consultant and allocated the latter to a high- (70th centile with 8/22 consultants) or low-volume (14/22 consultants) category. We examined outcomes (LOS and in-hospital 30-day mortality), by these cut-offs employing logistic regression to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  The hospital LOS was shorter (P < 0.001) for high [median 4.2, inter-quartile range (IQR) 1.7, 8.7] compared with the lower volume group (median 4.8, IQR 1.9, 9.7). There was a reduced 30-day in hospital mortality for high-volume (8.2%) compared with low-volume consultants (9.6%: P < 0.01). An admission under a high-volume consultant was independently predictive of survival, after adjustment for other outcome predictors including co-morbidity; the relative risk reduction was 25% [OR 0.75 (95% CI 0.68-0.82): P < 0.001].
  
  
  CONCLUSIONS
  In an era of increasing specialization, these data provide support for the concept that the frequency of being 'on-call' contributes to maintaining competence with an associated improvement in patient outcomes.
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland. bernardsilke@physicians.ie.
authors.forename: R
authors.initials: R
authors.lastname: Conway
authors.forename: D
authors.initials: D
authors.lastname: O'Riordan
authors.forename: B
authors.initials: B
authors.lastname: Silke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003253:Consultants / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D010343:Patient Admission; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*