In many UK  hospitals patients referred to hospital by their family doctors may bypass the emergency department (ED) and be admitted straight to admissions units, where additional staff duplicate the assessment and investigation that would have been done in the ED. The ED continues to see self-presenting and emergency ambulance cases as well as patients who ‘spill over’ when the admission units are full.
The effect of the introduction of a Medical Admissions Unit (MAU) on times to key interventions for four acute medical conditions was assessed. Interventions were delivered significantly faster in the ED than on the MAU, which in turn provided specific interventions faster than the general medical wards.
The authors rightly conclude that acute admissions should be assessed in a dedicated unit fit for purpose. It would appear from their data that if the purpose is timely intervention, then the ED is the most fit.
Improvement in time to treatment following establishment of a dedicated medical admissions unit
Emerg Med J. 2009 Dec;26(12):878-80