PMID- 23728209
OWN - NLM
STAT- MEDLINE
DCOM- 20140903
LR  - 20130909
IS  - 1460-2393 (Electronic)
IS  - 1460-2393 (Linking)
VI  - 106
IP  - 9
DP  - 2013 Sep
TI  - Consultant volume, as an outcome determinant, in emergency medical admissions.
PG  - 831-7
LID - 10.1093/qjmed/hct119 [doi]
AB  - BACKGROUND: Increasing hospital or specialist volumes has been shown to improve 
      outcomes; there are little data on volumes and outcomes in emergency medical 
      admissions. We have examined the hospital length of stay (LOS) and 30-day 
      mortality for patients admitted under a consultant 'of the day' having high- or 
      low-admission volumes. METHODS: An analysis was performed on all emergency 
      medical patients admitted between 1 January 2002 and 31 December 2011, using 
      anonymous patient data. We calculated the numbers of unique patients admitted to 
      each 'on call' consultant and allocated the latter to a high- (70th centile with 
      8/22 consultants) or low-volume (14/22 consultants) category. We examined 
      outcomes (LOS and in-hospital 30-day mortality), by these cut-offs employing 
      logistic regression to calculate unadjusted and adjusted odds ratios (ORs) and 
      95% confidence intervals (CIs). RESULTS: The hospital LOS was shorter (P < 0.001) 
      for high [median 4.2, inter-quartile range (IQR) 1.7, 8.7] compared with the 
      lower volume group (median 4.8, IQR 1.9, 9.7). There was a reduced 30-day in 
      hospital mortality for high-volume (8.2%) compared with low-volume consultants 
      (9.6%: P < 0.01). An admission under a high-volume consultant was independently 
      predictive of survival, after adjustment for other outcome predictors including 
      co-morbidity; the relative risk reduction was 25% [OR 0.75 (95% CI 0.68-0.82): P 
      < 0.001]. CONCLUSION: In an era of increasing specialization, these data provide 
      support for the concept that the frequency of being 'on-call' contributes to 
      maintaining competence with an associated improvement in patient outcomes.
FAU - Conway, R
AU  - Conway R
AD  - Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland. 
      bernardsilke@physicians.ie.
FAU - O'Riordan, D
AU  - O'Riordan D
FAU - Silke, B
AU  - Silke B
LA  - eng
PT  - Journal Article
DEP - 20130531
PL  - England
TA  - QJM
JT  - QJM : monthly journal of the Association of Physicians
JID - 9438285
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Consultants/*statistics & numerical data
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Mental Competency
MH  - Middle Aged
MH  - Patient Admission
MH  - Treatment Outcome
MH  - Workload/*statistics & numerical data
EDAT- 2013/06/04 06:00
MHDA- 2014/09/04 06:00
CRDT- 2013/06/04 06:00
PHST- 2013/06/04 06:00 [entrez]
PHST- 2013/06/04 06:00 [pubmed]
PHST- 2014/09/04 06:00 [medline]
AID - hct119 [pii]
AID - 10.1093/qjmed/hct119 [doi]
PST - ppublish
SO  - QJM. 2013 Sep;106(9):831-7. doi: 10.1093/qjmed/hct119. Epub 2013 May 31.