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Impact of specialist care on clinical outcomes for medical emergencies

Stuart Moore, Islay Gemmell, Solomon Almond, Iain Buchan, Isameldin Osman, Andrew Glover, Peter Williams, Nadine Carroll and Jonathan Rhodes
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DOI: https://doi.org/10.7861/clinmedicine.6-3-286
Clin Med May 2006
Stuart Moore
Royal Liverpool University Hospital
MA
Roles: Project Director
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Islay Gemmell
Evidence for Population Health Unit, University of Manchester
PhD
Roles: Research Fellow
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Solomon Almond
Royal Liverpool University Hospital
FRCP
Roles: Consultant in Acute Medicine
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Iain Buchan
Evidence for Population Health Unit, University of Manchester
MD FFPH
Roles: Senior Lecturer in Public Health Information
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Isameldin Osman
Royal Liverpool University Hospital
MRCP(UK)
Roles: Consultant in Acute Medicine
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Andrew Glover
Royal Liverpool University Hospital
Roles: Corporate Information Manager
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Peter Williams
Royal Liverpool University Hospital
MD FRCP
Roles: Divisional Director of Medicine
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Nadine Carroll
Royal Liverpool University Hospital
MD FRCP
Roles: Consultant Geriatrician
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Jonathan Rhodes
School of Clinical Science, University of Liverpool
MD FRCP FMedSci
Roles: Professor of Medicine
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Abstract

General hospitals have commonly involved a wide range of medical specialists in the care of unselected medical emergency admissions. In 1999, the Royal Liverpool University Hospital, a 915-bed hospital with a busy emergency service, changed its system of care for medical emergencies to allow early placement of admitted patients under the care of the most appropriate specialist team, with interim care provided by specialist acute physicians on an acute medicine unit – a system we have termed 'specialty triage’. Here we describe a retrospective study in which all 133,509 emergency medical admissions from February 1995 to January 2003 were analysed by time-series analysis with correction for the underlying downward trend from 1995 to 2003. This showed that the implementation of specialty triage in May 1999 was associated with a subsequent additional reduction in the mortality of the under-65 age group by 0.64% (95% CI 0.11 to 1.17% P=0.021) from the 2.4% mortality rate prior to specialty triage, equivalent to approximately 51 fewer deaths per year. No significant effect was seen for those over 65 or all age groups together when corrected for the underlying trend. Length of stay and readmission rates showed a consistent downward trend that was not significantly affected by specialty triage. The data suggest that appropriate specialist management improves outcomes for medical emergencies, particularly amongst younger patients.

Key Words
  • acute medicine
  • mortality
  • outcome
  • specialism
  • © 2006 Royal College of Physicians
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Impact of specialist care on clinical outcomes for medical emergencies
Stuart Moore, Islay Gemmell, Solomon Almond, Iain Buchan, Isameldin Osman, Andrew Glover, Peter Williams, Nadine Carroll, Jonathan Rhodes
Clinical Medicine May 2006, 6 (3) 286-293; DOI: 10.7861/clinmedicine.6-3-286

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Impact of specialist care on clinical outcomes for medical emergencies
Stuart Moore, Islay Gemmell, Solomon Almond, Iain Buchan, Isameldin Osman, Andrew Glover, Peter Williams, Nadine Carroll, Jonathan Rhodes
Clinical Medicine May 2006, 6 (3) 286-293; DOI: 10.7861/clinmedicine.6-3-286
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