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Can additional experienced staff reduce emergency medical admissions?
  1. S Goodacre1,2,
  2. S Mason1,2,
  3. R Kersh1,
  4. A Webster1,
  5. N Samaniego3,
  6. F Morris1
  1. 1Accident and Emergency Department, Northern General Hospital, Sheffield, UK
  2. 2Medical Care Research Unit, University of Sheffield, Sheffield, UK
  3. 3Department of Care for the Elderly, Royal Hallamshire Hospital, Sheffield, UK
  1. Correspondence to:
 Dr S Goodacre
 87A Sydney Road, Sheffield, S6 3GG, UK;


Background: Increases in emergency medical admissions are placing a strain upon hospitals throughout the world. The aim of the study was to evaluate the effect of a new post, the “A&E physician”, upon emergency medical admissions to a hospital.

Methods: For six months the A&E physician workload was audited and a randomised controlled comparison undertaken. Days were randomised to “A&E physician present” or “A&E physician absent”. The A&E physician recorded details of all patients referred for medical admission, any intervention made, and their disposal from A&E. Routine hospital data compared the mean daily number of medical admissions, non-medical admissions, and referrals to other hospitals.

Results: 124 days were randomised: 59 to A&E physician present, 65 to A&E physician absent. The A&E physician received 581 referrals and intervened in the management of 142 (24%). Of these, 80 were discharged home, apparently saving 1.4 admissions per day. However, randomised comparison showed that presence of the A&E physician was associated with a reduction of only 0.7 medical admissions per day (95% CI −1.7 to 3.2, p = 0.561), and an increase of 1.1 non-medical admissions (95% CI −0.2 to 2.3, p = 0.09) and 0.3 transfers to other hospitals per day (95% CI zero to 0.6, p = 0.09). Overall, hospital admissions were increased by 0.9 per day when the A&E physician was present (95% CI −1.8 to 3.6, p = 0.5).

Conclusion: Despite receiving many referrals and discharging a substantial proportion of these patients home, the A&E physician did not significantly change emergency medical admissions and may have increased admissions to other specialties.

  • staffing
  • hospital admission

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  • Funding: this project was funded by the Northern General Hospital Accident and Emergency Department. SG was supported by a Trent R&D Health Services Research Fellowship.

  • Conflicts of interest: none declared.