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Impact of emergency care centralisation on mortality and efficiency: a retrospective service evaluation

Lookup NU author(s): Professor Christopher Price, Selina McCarthy, Dr Peter McMeekin

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by BMJ Publishing Group, 2020.

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Abstract

Objective Evidence 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 emergency department (ED) to specialty wards with consultant presence 8am-8pm. Methods Consecutive unscheduled adult index admissions from matching postcode areas were identified retrospectively in Hospital Episode Statistics over a three-year period: pre-centralisation Baseline (16/06/2014 to 15/06/2015; n=18,586), Year 1 post-centralisation (16/06/2015 to 15/06/2016; n=16,126) and Year 2 post-centralisation (16/06/2016 to 15/06/2017; n=17,727). Logistic regression including key demographic co-variates compared Baseline to Year 1 and Year 2 probabilities of mortality and daily discharge until Day 60 after admission, and readmission within 60 days of discharge. Results Relative to Baseline, admission post-centralisation was associated with favourable odds ratios (95% CI) for Day 60 mortality (Year1: 0.95 (0.88 to 1.02), p=0.18; Year2: 0.94 (0.91 to 0.97), p<0.01), mainly amongst patients aged 80+ years (Year1: 0.88 (0.79 to 0.97); Year2: 0.91 (0.87 to 0.96)). The probability of discharge alive on any day since admission increased (Year1: 1.07 (1.04 to 1.10), p<0.01; Year2: 1.04 (1.02 to 1.05), p<0.01) and the risk of readmission decreased (Year1: 0.90 (0.87 to 0.94), p<0.01; Year2: 0.92 (0.90 to 0.94), p<0.01). Conclusion A 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.


Publication metadata

Author(s): Price CI, McCarthy S, Bate A, McMeekin P

Publication type: Article

Publication status: Published

Journal: Emergency Medicine Journal

Year: 2020

Pages: epub ahead of print

Online publication date: 07/01/2020

Acceptance date: 30/10/2019

Date deposited: 06/01/2020

ISSN (print): 1472-0205

ISSN (electronic): 1472-0213

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/emermed-2019-208539

DOI: 10.1136/emermed-2019-208539


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