Impact of specialist care on clinical outcomes for medical emergencies

General hospitals have commonly involved a wide range of medical specialists in the care of unselected medical emergency admis- sions. In 1999, the Royal Liverpool University Hospital, a 915-bed hospital with a busy emer- gency 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 retrospec- tive study in which all 133,509 emergency med- ical 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 imple- mentation of specialty triage in May 1999 was associated with a subsequent additional reduc- tion 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 down- ward trend that was not significantly affected by specialty triage. The data suggest that appro- priate specialist management improves outcomes for medical emergencies, particularly amongst younger patients.