• Marcus J Lyall, James Dear, Johanne Simpson, and Nazir Lone.
• Usher Institute for Population Health Sciences, University of Edinburgh, Edinburgh, UK v1mlyal2@ed.ac.uk.
• Clin Med (Lond). 2023 Sep 1; 23 (5): 458466458-466.

BackgroundThe effect of the duration of consultant experience on clinical outcomes in the acute medical unit (AMU) model remains unknown.MethodsUnscheduled AMU admissions (n=66,929) admitted by 56 consultant physicians between 2017 and 2020 to two large teaching hospital AMUs in Lothian, Scotland were examined. The associations of consultant experience on AMU with patient discharge, mortality, readmission and postdischarge death were calculated adjusting for clinical acuity, pathology and comorbidity.ResultsIncreasing consultant experience was associated with a continuous increase in likelihood of early AMU discharge (odds ratio (OR) 1.08; 95% confidence interval (CI) 1.07-1.10; p<0.001 per 5 years' experience), which persisted after adjustment for confounders (OR 1.06; 95% CI: 1.01-1.11; p=0.01). There was no association with early readmission, death after discharge or 30-day inpatient mortality. The marginal effect estimate translates into 31 (95% CI: 25-36), 41 (95% CI: 30-53) and 52 (95% CI: 35-71) additional safe discharges per 1,000 admissions for clinicians of 15, 20 and 25 years' experience, respectively compared with those recently completing training.ConclusionsIncreasing consultant physician experience associates with early safe discharge after AMU admission. These data suggest that the support and retention of experienced clinicians is vital if escalating pressures on unscheduled medical care are to be addressed.© Royal College of Physicians 2023. All rights reserved.

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