Specialist or generalist management of emergency medical admissions - immediate and long-term outcomes.

Abstract

To study whether the admission of unselected emergency medical patients, under either a Consultant with General Medicine (GIM) or Specialist accreditation, influenced either short or longer-term all-cause mortality. We report an observational cohort study of all emergency medical admissions admitted over 14 years between January 2011 and October 2024. The 30-day in-hospital and long-term all-cause mortality (10 year), were related to Consultant primary accreditation (GIM vs. Specialist), using logistic multiple variable regression or Cox proportional hazard models. There were 76,464 admissions in 42,104 unique patients over the period, with care delivered by 162 Consultants of whom 34 (21%) had a major GIM accreditation. The specialist load/on-call averaged 7.0 cases (IQR: 4.4, 9.0) in contrast to GIM at 12.1 cases (IQR: 11.7, 14.5). Over 14 years 30-day in-hospital all-cause mortality (per unique patient) declined from 2012 at 9.6% (95%CI: 8.4, 10.9) to 2024 at 2.9% (95%CI: 2.5, 3.4). Acute hospital mortality marginally favoured Specialty at 3.71% (95%CI: 3.54, 3.87) rather than GIM care GIM 4.10% (95%CI: 3.86, 4.34) with OR 1.12 (95%CI: 1.03, 1.22). Longer-term adjusted mortality was lower for the GIM admission cohort - HR 0.33 (95%CI: 0.24, 0.46) and for those admitted under Consultants with a higher volume (>5 cases) throughput - HR 0.77 (95%CI: 0.64, 0.94). These data suggest merits for GIM and Specialty care; short-term care favoured Specialist supervision, but overall long-term care proved better for GIM or higher volume Consultants.