Wow , what a memory!
This was when I was in Manchester
We had an A&E staff grade who had the facility to admit medical patients directly
to the ward without having to wait for the medical SHO to see them in A&E. We
looked at his average time to a decision to admit and his trolley wait times
and found they were much, much less than when patients were referred in the
usual way. We also found there was no significant difference in patients' subsequent
length of hospital stay or mortality.
Not a brilliant study, it was an attempt to show that senior A&E doctors are
capable of deciding that a patient needs admission,that they can decide what
initial management should be, that this reduces A&E times and that patient outcome
is not affected.
Having more senior doctors in A&E makes sense to me but I think we need more
research that shows they make things better.
The study in Leeds sound really good!
All the best,
Ross.
>I think Ross Murphy (SpR in Edinburgh) presented a poster on this at the
>faculty meeting. It concluded that direct admission from the ED was
>appropriate, safe and timely (if my memory serves me right).
>
>Simon
>Simon Carley
>SpR in Emergency Medicine
>[log in to unmask]
>Evidence based emergency medicine
>http://www.bestbets.org
>----- Original Message -----
>From: "Chris Kirke" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Friday, March 08, 2002 11:32 AM
>Subject: Re: bed pressures and admission avoidance
>
>
>> There is one paper I know of which sounds as though it is close to what
>you
>> want - at a hospital in Italy they introduced a system where senior
>internal
>> physicians saw patients in the Emergency Department. They monitored
>outcomes
>> before and after the change. They found something like a 20% reduction in
>> admissions with no worsening of clinical outcomes. This study was about 15
>> years ago. I can't remember the citation, but if you are interested let me
>> know and I will dig it out.
>>
>> There are quite a few studies which may not be exactly what you want:
>>
>> * diagnostic accuracy and appropriateness of admission when admission is
>> decided by A&E SHOs compared with when admission is decided by specialty
>> SHOs: showed no difference (study in Belfast, early 1990's I think)
>>
>> * assessing the effect of physician experience on admissions for suspected
>> cardiac chest pain: senior doctors admitted more patients without an
>> increase in diagnostic accuracy (Ting, Goldman et al, 1991)
>>
>> * a study where consultants retrospectively evaluated the appropriateness
>of
>> paediatric admissions and judged 20% as inappropriate. There was no
>> difference between the appropriateness of junior paediatricians' and
>junior
>> A&E doctors' decisions (MacFaul et al, early 1990s)
>>
>> * interventional study where senior surgeons assessed patients at
>admission:
>> admission rates were decreased significantly (Gaskell et al, Ann Royal
>Coll
>> Surg Eng, 1995)
>>
>> And some more along similar lines...
>>
>> Let me know if you want details of these
>>
>> Chris Kirke
>>
>> ----- Original Message -----
>> From: <[log in to unmask]>
>> To: <[log in to unmask]>
>> Sent: Friday, March 08, 2002 9:40 AM
>> Subject: bed pressures and admission avoidance
>>
>>
>> > Dear all,
>> > I'm trying to dig out articles on admission avoidance - with regard to
>the
>> benefit or otherwise of "acute physicians" seeing medical patients in the
>> ED/rapid access clinics etc.
>> > There was the Hardy et al paper in EMJ last year, but that was more
>about
>> rehab/COTE.
>> > Ideally I'm trying to find evidence on senior (general) physicians
>seeing
>> acute medical patients in the ED, for rapid assessment and initiation of
>> treatment with early (next day?) follow up. Eg, ?PE, ?ACS, ?Headache,
>?TIA,
>> CQC, first fits - the sort of presentations that the on call medical
>juniors
>> usually admit for later investigation/obs.
>> > Using OVID Medline hasn't been helpful so far. Any one on the list know
>of
>> any good papers?
>> > Thanks,
>> > Giles Cattermole
>> > SpR EM, Cardiff
>>
>
>
>
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