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The impact of consultant delivered service in emergency medicine: the Wrexham Model
  1. Aruni Sen1,
  2. David Hill2,
  3. Dilip Menon1,
  4. Fiona Rae1,
  5. Hywel Hughes1,
  6. Robin Roop1
  1. 1Emergency Department, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
  2. 2Department of Performance Improvement and Business Support, Betsi Cadwaladr University Health Board, Wrexham, UK
  1. Correspondence to Aruni Sen, Emergency Department Wrexham Maelor Hospital, Wrexham LL13 7TD; thesens{at}


Objective Consultant based delivery of emergency service is perceived to add value. This study aims to demonstrate the impact of such a service model based on consultant working in a UK emergency department.

Methods This retrospective study was based on the emergency department of a district general hospital. Activity data was analysed for 2009. Workload and admission rates were compared between consultants, middle grade doctors and senior house officers (SHOs). Admission rates were compared against two similar departments. Data from night shifts allowed consultant activity to be contrasted with middle grades and SHOs. Time spent in the department, admission rates, patients who left without treatment, discharged outright and clinic returns were used for comparison.

Results Consultants often saw more patients than SHOs or middle grade doctors. This was on top of their traditional duties of senior opinion. On comparison of activity at night shifts, they admitted fewer (25.2% vs 30.3%, p=0.026), had fewer leaving without treatment (1.6% vs 5.1%, p<0.001), discharged more outright (59.8% vs 47.5%, p<0.001), referred fewer to clinic (5.7% vs 6.6%, p=0.49) and had a faster turnaround time (p<0.001: Priority 2, 3 and 4) for every triage category. Some of the comparisons were clinically but not statistically significant.

Conclusion A consultant based service delivery offers many advantages. These cannot be matched by either junior or middle grades. This would be in addition to the consultants' supervisory role. Consultant expansion is urgently required to achieve this sustainably. A further study evaluating the cost benefits of this service model is now underway.

  • Consultant delivered service
  • consultant workload
  • senior based service delivery
  • 4-h target performance, length of stay
  • audit
  • emergency care systems
  • emergency care systems
  • admission aviodance
  • emergency care systems
  • effieciency
  • management
  • risk management

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  • Competing interests None.

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

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