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Impact of senior clinical review on patient disposition from the emergency department
  1. Alison L White,
  2. Peter A R Armstrong,
  3. Shobhan Thakore
  1. Emergency Department, Ninewells Hospital and Medical School, Dundee, UK
  1. Correspondence to Dr Alison L White, Emergency Department, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK; awhite4{at}


Introduction The delivery of high quality emergency medicine ideally involves input from senior doctors 24 h a day. This study aims to assess the influence of ‘real-time’ senior clinician supervision on patient disposition from a UK emergency department.

Methods The study was set in a UK teaching hospital with 24 h senior cover. Patients were initially seen by a junior doctor who completed a plan for the patient before seeking senior advice. Primary outcome measures were a change in patient outcome of discharge, admit, telephone speciality for opinion or outpatient follow-up.

Results 556 patients underwent senior review during the study period. Review reduced inpatient admissions by 11.9% (95% CI 7.2% to 18.2%) and specifically reduced admissions to the acute medical assessment unit by 21.2% (95% CI 13.5% to 30.8%). Inappropriate discharge was prevented in 9.4% (95% CI 6.2% to 13.7%) and appropriate use of outpatient facilities resulted in a rise of 34.6% in appointments.

Conclusions Senior doctor input in patient care in the ED adds accuracy to disposition decisions, impacting on patient safety and improving departmental flow.

  • Emergency Department
  • clinician
  • clinical governance
  • admission
  • clinical assessment
  • emergency care systems
  • advanced practitioner
  • management
  • risk management

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  • Competing interests None.

  • Ethics approval Neither ethics approval nor patient consent was required for this study as there were no changes to normal department practice. However, all doctors involved provided verbal consent with the understanding that all forms were anonymised.

  • Provenance and peer review Not commissioned; externally peer reviewed.