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

AIM: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.