Closing hospital emergency departments does not result in more deaths but neither does it improve outcomes for patients, according to researchers who suggest the resulting public anxiety may not make the reorganisation of resources worthwhile.
The findings have emerged from the first study to examine the impact of closing accident and emergency departments on both patients and other emergency services.
Last year an analysis of local plans, carried out by the British Medical Association, suggested that 22.9m patients “could be affected by A&Es closing or downgrading”.
Researchers from Sheffield university examined what happened after five emergency departments in England were downgraded between 2009 and 2011, concluding there was “no impact on death rates upward or downward, despite patients having to travel further to access emergency care”.
However, in a setback for NHS policymakers, closing emergency departments and re-organising emergency services did not improve outcomes for patients either.
Their report was funded and published by the National Institute for Health Research (NIHR), which is in turn funded by the department of health and social care.
Emma Knowles, of Sheffield’s School of Health and Related Research (ScHARR), said that any negative effects caused by an increase in journey time to an emergency department seemed to be offset by other factors, such as the introduction of new specialised services “or if the care received at the now nearest hospital is more effective than that provided at the hospital where the ED closed”.
However, the study’s co-author, Jon Nicholl, professor of health services at ScHARR, said it was important to highlight “that we didn’t find the better outcomes for patients that planners hoped to see from closing these small departments either.
“This means it isn’t clear that the disruption and anxiety that can be caused by closing emergency departments is worthwhile,” he added.
The researchers, whose work centred on Newark, Rochdale, Hartlepool, Bishop Auckland and Hemel Hempstead, also found evidence to suggest an increase in the number of incidents that were dealt with by the ambulance service across the five areas. “The increase was above and beyond the national increase”, they said, suggesting the emergency department closures “may have contributed to a higher workload within these areas”, they said.
On the financial impact of the reorganisation, the report said the average cost of an A&E visit was £138 in 2015/16 and the cost of an unplanned inpatient stay was £1,609. Acknowledging that the closure or downgrade of an emergency department “may have financial implications”, they suggest further research was needed to be conducted “to examine this important aspect of the reorganisation on the emergency and urgent care system”.
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