Impact of senior clinical review on patient disposition from the emergency department. Issue 4 (12th April 2010)

• Record Type: Journal Article
• Authors: White, Alison L; Armstrong, Peter A R; Thakore, Shobhan
• Is Part Of: Emergency medicine journal. Volume 27:Issue 4(2010)
• Page Start: 262
• Page End: 265
• Publication Date: 2010-04-12
• Subjects: Emergency Department -- clinician -- clinical governance -- admission -- clinical assessment -- emergency care systems -- advanced practitioner -- management -- risk management; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emj.2009.077842
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : 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.