title: Admission of medical patients from the emergency department: An assessment of the attitudes, perspectives and practices of internal medicine and emergency medicine trainees.
abstract: OBJECTIVE
  We sought to obtain a deeper understanding of the differing needs and expectations of inpatient and ED medical staff regarding the admission process for medical patients.
  
  
  METHODS
  Online questionnaire regarding their attitudes to and perceptions of various aspects of the admission process was used.
  
  
  METHODS
  The setting is a tertiary 640-bed adult hospital with over 60 000 ED presentations per year and an inpatient admission rate of 30%.
  
  
  RESULTS
  A total of 42 out of 56 (75%) internal medical trainees (IMT) felt that the ED admission workup standard was lower or much lower than the inpatient standard; however, 10 of 16 (62.5%) ED trainees (EDT) thought it was similar (P = 0.009). Regarding why IMT order additional tests in the ED, the major reason supported by IMT was to 'identify or exclude urgent pathology' (53/56, 96.4%); however, this reason ranked only fifth for EDT (2/16, 12.5%) who ranked 'to ensure nothing was missed' (12/15, 80%) first. A total of 24 out of 56 (42.8%) IMT felt that if ED admissions were enacted without IMT review, inappropriate admissions to hospital would occur regularly although only one of 16 EDT (6.3%) agreed (P = 0.025). A total of 14 out of 16 (87.5%) EDT but only 16 of 56 (23.2%) IMT were comfortable with admissions occurring without inpatient review in the ED (P < 0.001). The top two perceived barriers to a smooth and timely admission process for IMT were patient instability (34/43, 79.1%) and inadequate ED workup (37/49, 75.5%); for EDT, they were excessive IMT workload (11/14, 78.6%) and referral close to the end of an IMT shift (7/11, 63.6%).
  
  
  CONCLUSIONS
  Substantial barriers to more harmonious admission processes exist. A 'paradigm shift' where roles and responsibilities are clear might be required. Defusing tension across the ED-inpatient interface should improve efficiency and ensure that patient outcomes remain the focus.
authors.affiliation: Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Sean
authors.identifier: http://orcid.org/0000-0002-7124-1616
authors.initials: S
authors.lastname: Lawrence
authors.affiliation: Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|Physician Training Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|School of Medicine, University of Queensland, Brisbane, Queensland, Australia.|Mater Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Clair
authors.initials: C
authors.lastname: Sullivan
authors.affiliation: Physician Training Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Nadia
authors.initials: N
authors.lastname: Patel
authors.affiliation: Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Lyndall
authors.initials: L
authors.lastname: Spencer
authors.affiliation: Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Sinnott
authors.affiliation: Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Rob
authors.initials: R
authors.lastname: Eley
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D062209:Patient Handoff; D061214:Patient Safety; D011793:Queensland; D011795:Surveys and Questionnaires
keywords: emergency department; internal medicine; patient admission; referral