In this article, the author describes the development of a medical admissions unit. He also highlights the introduction of an advanced nurse practitioner role and the contribution this has made to raising the quality of patient care

Concerns about risk management in A&E departments are compounded by increasing numbers of patients and staff shortages. These factors have led to patients remaining in A&E departments for far longer than is necessary. The Clinical Standards Advisory Group (CSAG) reported excessively long periods of stay for patients attending A&E departments (CSAG 1995). The group examined the management of 8,000 urgent or emergency admissions in 30 hospitals throughout the UK. The findings illustrated large variations in admission times depending on specialty, admission management, the type of hospital and geographical location. The report concluded that occupancy rates in A&E departments must be reduced to allow staff to cope with emergency admissions.