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Impact of emergency care centralisation on mortality and efficiency: a retrospective service evaluation
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Impact of emergency care centralisation on mortality and efficiency: a retrospective service evaluation
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Impact of emergency care centralisation on mortality and efficiency: a retrospective service evaluation
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Journal Article
Impact of emergency care centralisation on mortality and efficiency: a retrospective service evaluation
2020
Overview
ObjectiveEvidence favours centralisation of emergency care for specific conditions, but it remains unclear whether broader implementation improves outcomes and efficiency. Routine healthcare data examined consolidation of three district general hospitals with mixed medical admission units (MAU) into a single high-volume site directing patients from the ED to specialty wards with consultant presence from 08:00 to 20:00.MethodsConsecutive unscheduled adult index admissions from matching postcode areas were identified retrospectively in Hospital Episode Statistics over a 3-year period: precentralisation baseline (from 16 June 2014 to 15 June 2015; n=18 586), year 1 postcentralisation (from 16 June 2015 to 15 June 2016; n=16 126) and year 2 postcentralisation (from 16 June 2016 to 15 June 2017; n=17 727). Logistic regression including key demographic covariates compared baseline with year 1 and year 2 probabilities of mortality and daily discharge until day 60 after admission and readmission within 60 days of discharge.ResultsRelative to baseline, admission postcentralisation was associated with favourable OR (95% CI) for day 60 mortality (year 1: 0.95 (0.88 to 1.02), p=0.18; year 2: 0.94 (0.91 to 0.97), p<0.01), mainly among patients aged 80+ years (year 1: 0.88 (0.79 to 0.97); year 2: 0.91 (0.87 to 0.96)). The probability of being discharged alive on any day since admission increased (year 1: 1.07 (1.04 to 1.10), p<0.01; year 2: 1.04 (1.02 to 1.05), p<0.01) and the risk of readmission decreased (year 1: 0.90 (0.87 to 0.94), p<0.01; year 2: 0.92 (0.90 to 0.94), p<0.01).ConclusionA centralised site providing early specialist care was associated with improved short-term outcomes and efficiency relative to lower volume ED admitting to MAU, particularly for older patients.
Publisher
BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine,BMJ Publishing Group LTD,BMJ Publishing Group
Subject
/ Centralized Hospital Services - methods
/ Centralized Hospital Services - standards
/ Centralized Hospital Services - statistics & numerical data
/ Efficiency, Organizational - standards
/ Efficiency, Organizational - statistics & numerical data
/ emergency care systems, efficiency
/ Emergency Medical Services - methods
/ Emergency Medical Services - standards
/ Emergency Medical Services - statistics & numerical data
/ England
/ Female
/ Hospitalization - statistics & numerical data
/ Humans
/ Male
