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Emergency departments are pressed to reduce avoidable acute admissions and breaches in the 4-hour target wait. In response four studied hospitals developed new models of care including a hospital-based Acute GP Service; a multidisciplinary ‘frailty’ team; pathways to community-based specialist reviews; ‘space’ outside the ED to observe, investigate, treat and review patients; and diverse deployment of senior emergency care consultants to ‘cherry pick’ patients needing expertise and to oversee and ‘control’ the whole system in partnership with other staff.

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Jonathan Pinkney,1,* Susanna Rance,1,2 Jonathan Benger,3 Heather Brant,4 Sian Joel-Edgar,5 Dawn Swancutt,1 Debra Westlake,1 Mark Pearson,6 Daniel Thomas,1 Ingrid Holme,7 Ruth Endacott,8 Rob Anderson,6 Michael Allen,6 Sarah Purdy,4 John Campbell,6 Rod Sheaff,9 Richard Byng,1 

1 Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
2 Institute for Health and Human Development, University of East London, London, UK
3 Department of Nursing and Midwifery, University of the West of England, Bristol, UK
4 School of Social and Community Medicine, University of Bristol, Bristol, UK
5 University of Exeter Business School, Exeter, UK
6 University of Exeter Medical School, Exeter, UK
7 Faculty of Social Sciences, University of Ulster, Londonderry, UK
8 Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
9 School of Government, Faculty of Business, Plymouth University, Plymouth, UK
* Corresponding author ; Email:

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