title: Reinforcement of emergency department reduces acute admissions to medical department.
abstract: BACKGROUND
  The medical decision capacity of emergency departments (ED) may rest within the department itself or depend on external consultation. The stepwise development of the ED at Zealand University Hospital, Køge, was used to analyse the influence of medical organisation in the ED on the hospital admission pattern.
  
  
  METHODS
  Data were recorded for the month of September of 2009, 2012 and 2014. These periods corresponded to the establishment of the department in 2009 and the 2012-period before organisational change was initiated in 2013, with a substantial increase in the number of senior physicians directly in charge of clinical decisions and the establishment of a limited bedding capacity. In 2014, the changes had been fully implemented. We analysed the number of patients admitted and their length of stay (LOS) in the ED and in the Department of Internal Medicine (DoM). The 30-day readmission and mortality rates were used as quality indicators.
  
  
  RESULTS
  A total of 1,106, 1,354 and 1,470 patients were admitted to the ED in 2009, 2012 and 2014, respectively. In 2009 and 2012, 42% of the patients were admitted to the DoM. In 2014, only 22% were admitted. The mean LOS for long-term admission at the DoM increased by 1.4 days from 2009 to 2014. Readmission and mortality rates did not change in three periods analysed.
  
  
  CONCLUSIONS
  Independent medical decision capacity and bed resources in the ED effectively change hospital logistics and reduce the number of admissions without negatively affecting patient safety in terms of readmission or short-term mortality.
  
  
  BACKGROUND
  none.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: jacob.schwartz@dadlnet.dk.
authors.forename: Mansoor Ahmed
authors.initials: MA
authors.lastname: Dawood
authors.forename: Gideon
authors.initials: G
authors.lastname: Ertner
authors.forename: Jacob
authors.initials: J
authors.lastname: Hansen-Schwartz
mesh_terms: D000367:Age Factors; D000368:Aged; D000066491:Clinical Decision-Making; D003718:Denmark; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D010343:Patient Admission / Q000706:statistics & numerical data* / Q000639:trends; D010359:Patient Readmission / Q000639:trends; D011787:Quality of Health Care