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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