title: How do clinicians with different training backgrounds manage walk-in patients in the ED setting?
abstract: OBJECTIVE
  To compare the initial assessment and management of walk-in emergency department (ED) patients between different types of healthcare providers.
  
  
  METHODS
  A large teaching hospital with an annual ED census of 140 000 adult patients.
  
  
  METHODS
  A random sample of 384 patients who self-presented to the ED was obtained. A detailed analysis of each patient record was performed by two clinicians. Data were obtained on the presenting condition, and disposition of each patient, either into the ED for further assessment, or discharge.
  
  
  RESULTS
  GPs were significantly more likely to discharge patients home as compared to emergency nurses. ED senior nurses were more likely than GPs to stream patients into the ED for further assessment. Of the patients referred into the ED for further assessment by senior ED nurses, the majority were discharged home. There were insufficient numbers of emergency physician assessments for meaningful statistical analysis.
  
  
  CONCLUSIONS
  The clinician groups studied here demonstrated different patterns of discharge and referral, reflecting their training and experience. When planning operational procedures, the training and background of the staff allocated to each area should be considered.
authors.affiliation: Emergency Department, The Royal London Hospital, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Harris
authors.affiliation: GP Health E1 Homeless Medical Centre and Clinical Lead GP Streaming Service, Barts Health NHS Trust, London, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: McDonald
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003441:Crowding; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D006282:Health Personnel / Q000458:organization & administration; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors; D006113:United Kingdom
keywords: clinical assessment; emergency care systems, admission avoidance; emergency care systems, efficiency; emergency care systems, emergency departments; emergency departments