Downgrading EDs does not increase number of deaths, study finds

Researchers find the effects of increased journey times to EDs are offset by other factors

Downgrading emergency departments (EDs) does not lead to a spike in deaths – despite patients having to travel further for emergency care, a new study suggests.

But downgrading or closing units may heap pressure on local ambulance services, the researchers found.

The closure of EDs sparks much debate in local communities, but there has been little research into its effects.

EDs can be downgraded – for example, by changing them from 24-hour consultant-led to a minor injuries or urgent care departments – or closed – for instance when services are disrupted because of staffing problems or reorganisation.

Researchers from the University of Sheffield set out to examine the effect of downgrading five EDs in England between 2009 and 2011.

Negative effects

The study, which evaluated EDs in Newark, Rochdale, Hartlepool, Bishop Auckland and Hemel Hempstead before and after they were downgraded, found no overall increase in the number of deaths.

‘This suggests that any negative effects caused by increased journey time to the ED can be offset by other factors. For example, if other new services are introduced and care becomes more effective than it used to be, or if the care received at the now-nearest hospital is more effective than that provided at the hospital where the ED closed,’ the authors wrote.

They added that downgrading EDs has implications for other NHS emergency care providers, such as an increase in the number of calls to ambulance services.

The authors noted increases in the number of incidents dealt with by ambulance services and in the time taken to get to hospital, according to the study published by the National Institute for Health Research.

Reassurance

The study points out that, in four of the five areas studied, EDs were replaced by on-site urgent care facilities.

University of Sheffield School of Health and Related Research senior research fellow Emma Knowles, said: ‘The public require reassurance that the closure or downgrade of an ED does not result in increased death rates.’

Study co-author, Professor Jon Nicholl, added: ‘We didn’t find the better outcomes for patients that planners hoped to see from closing these small departments.

‘This means it is not clear that the disruption and anxiety that can be caused by closing emergency departments is worthwhile.’

Related material

• Link to the study

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