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  • Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment

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Emergency medicine
Research
Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment
  1. Adrian A Boyle1,
  2. Vazeer Ahmed1,
  3. Christopher R Palmer2,
  4. Tom J H Bennett3,
  5. Susan M Robinson1
  1. 1Emergency Department, Cambridge University Foundation Hospitals NHS Trust, Cambridge, UK
  2. 2Centre for Medical Statistics, Cambridge University, Cambridge, UK
  3. 3Cambridge University Foundation Hospitals Trust, Cambridge, UK
  1. Correspondence to Dr Adrian A Boyle; adrian.boyle{at}addenbrookes.nhs.uk

Abstract

Objectives Reducing emergency admissions is a priority for the NHS. A single hospital's emergency care system was reorganised with the principles of front-loaded investigations, integration of specialties, reduced duplication, earlier decision making by senior clinicians and a combined emergency assessment area. The authors relocated our Medical Assessment Unit into our emergency department in 2006. The authors evaluated changes in admissions and mortality before and after 2006, compared with other similar hospitals.

Design Quasi-experimental before and after study using routinely collected data.

Setting and participants 1 acute hospital in England, the intervention site, was compared with 23 other English hospitals between 2001 and 2009.

Outcome measures Our outcome measures were hospital standardised mortality ratios (HSMRs) for non-elective admissions and standardised admission ratios (SARs).

Results The authors observed a statistically and clinically significant decrease in HSMR and SAR. The intervention hospital had the lowest HSMR and SAR of all the hospitals in our sample. This was statistically significant, p=0.0149 and p=0.0002, respectively.

Conclusion Integrating emergency care in one location is associated with a meaningful reduction in mortality and emergency admissions to hospital.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjopen-2012-000930

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    Supplementary materials

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    Footnotes

    • To cite: Boyle AA, Ahmed V, Palmer CR, et al. Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment. BMJ Open 2012;2:e000930. doi:10.1136/bmjopen-2012-000930

    • Contributors AAB and SMR initiated the project and developed the study protocol. VA and TJHB provided clinical and operational context, respectively, into the discussion. CP performed the statistical analysis. All authors contributed to the writing of the manuscript. AAB and SMR conceived the project. AAB and VA wrote the initial draft and analysed the results. TJHB contributed to the design and discussion. CP provided statistical analysis. All authors read and approved the final version of the paper.

    • Funding The study was funded by Addenbrookes Emergency Department Research Fund.

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no relevant unpublished data.