scholarly journals Determinants of Accident and Emergency Attendances and Emergency Admissions in Infants: Birth Cohort Study

2021 ◽  
Author(s):  
Selina Nath ◽  
Ania Zylbersztejn ◽  
Russell M. Viner ◽  
Mario Cortina-Borja ◽  
Kate Marie Lewis ◽  
...  
Keyword(s):  
Congenital Anomaly ◽  
Local Authority ◽  
Emergency Admission ◽  
Mixed Effects ◽  
Birth Cohort Study ◽  
Attendance Rates ◽  
Emergency Admissions ◽  
Individual Level ◽  
Admission Rates ◽  
Accident And Emergency

Abstract Background: Understanding of drivers in increasing infant accident and emergency (A&E) attendances and emergency hospital admissions across England is limited. We examine variations in use of emergency hospital services among infants by local areas in England and investigate the extent to which infant and socio-economic factors explain these variations.Methods: Birth cohort study using linked administrative Hospital Episode Statistics data in England. Singleton live births between 1 April 2012 and 31 March 2019 were followed up for 1 year; from 1 April 2013 (from the discharge date of their birth admission) until their first birthday, death or 31 March 2019. Mixed effects negative binomial models were used to calculate incidence rate ratios for A&E attendances and emergency admissions and mixed effects logistic regression models estimated odds ratio of conversion (the proportion of infants subsequently admitted after attending A&E). Models were adjusted individual-level factors and included a random effect for local authority (LA).Results: The cohort comprised 3,665,414 births in 150 English LAs. Rates of A&E attendance and emergency admissions were highest amongst: infants born <32 weeks gestation; with presence of congenital anomaly; and to mothers <20-years-old. Area-level deprivation was positively associated with A&E attendance rates, but not associated with conversion probability. A&E attendance rates were highest in the North East (916 per 1000 child-years, 95%CI: 911 to 921) and London (876 per 1000, 95%CI: 874 to 879), yet London had the lowest emergency admission rates (232 per 1000, 95%CI: 231 to 234) and conversion probability (25% vs highest 39% in South West). Adjusting for individual-level factors did not significantly affect variability in A&E attendance and emergency admission rates by local authority.Conclusions: Drivers of A&E attendances and emergency admissions include individual-level factors such being born premature, with congenital anomaly and from socio-economically disadvantaged young parent families. Support for such vulnerable infants and families should be provided alongside preventative health care in primary and community care settings. Substantial geographical variations in rates were not explained by individual-level factors, suggest more detailed understanding of local and underlying service-level factors would provide targets for further research on mechanisms and policy priority.

scholarly journals Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

2016 ◽  
Vol 40 (2) ◽  
pp. 149 ◽  
Author(s):  
Clair Sullivan ◽  
Andrew Staib ◽  
Rob Eley ◽  
Bronwyn Griffin ◽  
Rohan Cattell ◽  
...  
Keyword(s):  
Palliative Care ◽  
Mortality Rate ◽  
Older Patients ◽  
Emergency Admission ◽  
Emergency Admissions ◽  
Admission Rates ◽  
Triage Category ◽  
After Hours ◽  
Mode Of Transport ◽  
National Emergency

Objective The aim of the present study was to identify patient and non-patient factors associated with reduced mortality among patients admitted from the emergency department (ED) to in-patient wards in a major tertiary hospital that had previously reported a near halving in mortality in association with a doubling in National Emergency Access Target (NEAT) compliance over a 2-year period from 2012 to 2014. Methods We retrospectively analysed routinely collected data from the Emergency Department Information System (EDIS) and hospital discharge abstracts on all emergency admissions during calendar years 2011 (pre-NEAT interventions) and 2013 (post-NEAT interventions). Patients admitted to short-stay wards and then discharged home, as well as patients dying in the ED, were excluded. Patients included in the study were categorised according to age, time and day of arrival to the ED, mode of transport to the ED, emergency triage category, type of clinical presentation and major diagnostic codes. Results The in-patient mortality rate for emergency admissions decreased from 1.9% (320/17 022) in 2011 to 1.2% (202/17 162) in 2013 (P < 0.001). There was no change from 2011 to 2013 in the percentage of deaths in the ED (0.19% vs 0.17%) or those coded as in-patient palliative care (17.9% vs 22.2%). Although deaths were not associated with age by itself, the mortality rate of older patients admitted to medical wards decreased significantly from 3.5% to 1.7% (P = 0.011). A higher mortality rate was seen among patients presenting to ED triage between midnight and 12 noon than at other times in 2011 (2.5% vs 1.5%; P < 0.001), but this difference disappeared by 2013 (1.3% vs 1.1%; P = 0.150). A similar pattern was seen among patients presenting on weekends versus weekdays: 2.2% versus 1.7% (P = 0.038) in 2011 and 1.3% versus 1.1% (P = 0.150) in 2013. Fewer deaths were noted among patients with acute cardiovascular or respiratory disease in 2013 than in 2011 (1.7% vs 3.6% and 1.5% vs 3.4%, respectively; P < 0.001 for both comparisons). Mode of transport to the ED or triage category was not associated with changes in mortality. These analyses took account of any possible confounding resulting from differences over time in emergency admission rates. Conclusions Improved NEAT compliance as a result of clinical redesign is associated with improved in-patient mortality among particular subgroups of emergency admissions, namely older patients with complex medical conditions, those presenting after hours and on weekends and those presenting with time-sensitive acute cardiorespiratory conditions. What is known about the topic? Clinical redesign aimed at improving compliance with NEAT and reducing time spent within the ED of acutely admitted patients has been associated with reduced mortality. To date, no study has attempted to identify subgroups of patients who potentially derive the greatest benefit from improved NEAT compliance in terms of reduced risk of in-patient death. It also remains unclear as to what extent non-patient factors (e.g. admission practices and differences in coding of palliative care patients) affect or confound this reduced risk. What does this paper add? The present study is the first to reveal that enhanced NEAT compliance is associated with lower mortality among particular subgroups of emergency patients admitted to in-patient wards. These include older patients with complex medical conditions, those presenting after hours or on weekends or those with time-sensitive acute cardiorespiratory conditions. These results took account of any possible confounding resulting from differences over time in emergency admission rates, deaths in the ED, numbers of short-stay ward admissions and coding of palliative care deaths. What are the implications for practitioners? Efforts aimed at improving NEAT compliance and efficiencies at the ED–in-patient interface appear to be worthwhile in reducing in-patient mortality among particular subgroups of emergency admissions at high risk. More research is urgently needed in identifying patient- and system-level factors that predispose to higher mortality rates in such populations, but are potentially amenable to focused interventions aimed at optimising transitions of care at the ED–in-patient interface and increasing NEAT compliance for patients admitted to in-patient wards from the ED.

Drivers of potentially avoidable emergency admissions in Ireland: an ecological analysis

2018 ◽  
Vol 28 (6) ◽  
pp. 438-448 ◽  
Author(s):  
Brenda Lynch ◽  
Anthony P Fitzgerald ◽  
Paul Corcoran ◽  
Claire Buckley ◽  
Orla Healy ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Private Health Insurance ◽  
Insurance Coverage ◽  
Emergency Admission ◽  
Health Insurance Coverage ◽  
County Level ◽  
Emergency Admissions ◽  
Admission Rates ◽  
System Factors

BackgroundMany emergency admissions are deemed to be potentially avoidable in a well-performing health system.ObjectiveTo measure the impact of population and health system factors on county-level variation in potentially avoidable emergency admissions in Ireland over the period 2014–2016.MethodsAdmissions data were used to calculate 2014–2016 age-adjusted emergency admission rates for selected conditions by county of residence. Negative binomial regression was used to identify which a priori factors were significantly associated with emergency admissions for these conditions and whether these factors were also associated with total/other emergency admissions. Standardised incidence rate ratios (IRRs) associated with a 1 SD change in risk factors were reported.ResultsNationally, potentially avoidable emergency admissions for the period 2014–2016 (266 395) accounted for 22% of all emergency admissions. Of the population factors, a 1 SD change in the county-level unemployment rate was associated with a 24% higher rate of potentially avoidable emergency admissions (IRR: 1.24; 95% CI 1.04 to 1.41). Significant health system factors included emergency admissions with length of stay equal to 1 day (IRR: 1.20; 95% CI 1.11 to 1.30) and private health insurance coverage (IRR: 0.92; 95% CI 0.89 to 0.96). The full model accounted for 50% of unexplained variation in potentially avoidable emergency admissions in each county. Similar results were found across total/other emergency admissions.ConclusionThe results suggest potentially avoidable emergency admissions and total/other emergency admissions are primarily driven by socioeconomic conditions, hospital admission policy and private health insurance coverage. The distinction between potentially avoidable and all other emergency admissions may not be as useful as previously believed when attempting to identify the causes of regional variation in emergency admission rates.

scholarly journals Has the introduction of direct oral anticoagulants (DOACs) in England increased emergency admissions for bleeding conditions? A longitudinal ecological study

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033357 ◽  
Author(s):  
Ana Alfirevic ◽  
Jennifer Downing ◽  
Konstantinos Daras ◽  
Terence Comerford ◽  
Munir Pirmohamed ◽  
...  
Keyword(s):  
Ecological Study ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Emergency Admission ◽  
Bleeding Complications ◽  
Annual Number ◽  
Emergency Admissions ◽  
Admission Rates ◽  
Complications Rate

ObjectiveThere is concern about long-term safety of direct oral coagulants (DOACs) in clinical practice. Our aim was to investigate whether the introduction of DOACs compared with vitamin-K antagonists in England was associated with a change in admissions for bleeding or thromboembolic complications.Setting5508 General practitioner (GP) practices in England between 2011 and 2016.ParticipantsAll GP practices in England with a registered population size of greater than 1000 that had data for all 6 years.Main outcome measureThe rate of emergency admissions to hospital for bleeding or thromboembolism, per 100 000 population for each GP practice in England.Main exposure measureThe annual number of DOAC items prescribed for each GP practice population as a proportion of all anticoagulant items prescribed.DesignThis longitudinal ecological study used panel regression models to investigate the association between trends in DOAC prescribing within GP practice populations and trends in emergency admission rates for bleeding and thromboembolic conditions, while controlling for confounders.ResultsFor each additional 10% of DOACs prescribed as a proportion of all anticoagulants, there was a 0.9% increase in bleeding complications (rate ratio 1.008 95% CI 1.003 to 1.013). The introduction of DOACs between 2011 and 2016 was associated with additional 4929 (95% CI 2489 to 7370) emergency admissions for bleeding complications. Increased DOAC prescribing was associated with a slight decline in admission for thromboembolic conditions.ConclusionOur data show that the rapid increase in prescribing of DOACs after changes in National Institute for Health and Care Excellence guidelines in 2014 may have been associated with a higher rate of emergency admissions for bleeding conditions. These consequences need to be considered in assessing the benefits and costs of the widespread use of DOACs.

scholarly journals Evaluating the Effectiveness of a Local Primary Care Incentive Scheme: A Difference-in-Differences Study

2021 ◽  
pp. 107755872110352
Author(s):  
Esmaeil Khedmati Morasae ◽  
Tanith C. Rose ◽  
Mark Gabbay ◽  
Laura Buckels ◽  
Colette Morris ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Financial Incentive ◽  
Emergency Admission ◽  
Difference In Differences ◽  
Emergency Admissions ◽  
North West ◽  
Admission Rates ◽  
The North ◽  
Improvement Scheme

National financial incentive schemes for improving the quality of primary care have come under criticism in the United Kingdom, leading to calls for localized alternatives. This study investigated whether a local general practice incentive-based quality improvement scheme launched in 2011 in a city in the North West of England was associated with a reduction in all-cause emergency hospital admissions. Difference-in-differences analysis was used to compare the change in emergency admission rates in the intervention city, to the change in a matched comparison population. Emergency admissions rates fell by 19 per 1,000 people in the years following the intervention (95% confidence interval [17, 21]) in the intervention city, relative to the comparison population. This effect was greater among more disadvantaged populations, narrowing socioeconomic inequalities in emergency admissions. The findings suggest that similar approaches could be an effective component of strategies to reduce unplanned hospital admissions elsewhere.

scholarly journals Emergency paediatric critical care in England: describing trends using routine hospital data

2020 ◽  
Vol 105 (11) ◽  
pp. 1061-1067 ◽  
Author(s):  
Kate Marie Lewis ◽  
Sanjay M Parekh ◽  
Padmanabhan Ramnarayan ◽  
Ruth Gilbert ◽  
Pia Hardelid ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Birth Cohort Study ◽  
Invasive Ventilation ◽  
Hospital Data ◽  
Emergency Admissions ◽  
Admission Rates ◽  
Dependency Care ◽  
High Dependency ◽  
High Dependency Care

ObjectiveTo determine trends in emergency admission rates requiring different levels of critical care in hospitals with and without a paediatric intensive care unit (PICU).DesignBirth cohort study created from Hospital Episode Statistics.SettingNational Health Service funded hospitals in England.Patients8 577 680 singleton children born between 1 May 2003 and 31 April 2017.Outcome measuresUsing procedure and diagnostic codes, we assigned indicators of high dependency care (eg, non-invasive ventilation) or intensive care (eg, invasive ventilation) to emergency admissions.InterventionsChildren were followed up until their fifth birthday to estimate high dependency and intensive care admission rates in hospitals with and without a PICU. We tested the yearly trend of high dependency and intensive care admissions to hospitals without a PICU using logistic regression models.ResultsEmergency admissions requiring high dependency care in hospitals without a PICU increased from 3.30 (95% CI 3.09 to 3.51) per 10 000 child-years in 2008/2009 to 7.58 (95% CI 7.28 to 7.89) in 2016/2017 and overtook hospitals with a PICU in 2015/2016. The odds of an admission requiring high dependency care to a hospital without a PICU compared with a hospital with a PICU increased by 9% per study year (OR 1.09, 95% CI 1.08 to 1.10). The same trend was not present for admissions requiring intensive care (OR 1.01, 95% CI 0.99 to 1.03).ConclusionsBetween 2008/2009 and 2016/2017, an increasing proportion of admissions with indicators of high dependency care took place in hospitals without a PICU.

scholarly journals Are more GPs associated with a reduction in emergency hospital admissions?

2020 ◽  
pp. BJGP.2020.0737
Author(s):  
Catia Nicodemo ◽  
Barry McCormick ◽  
FD Richard Hobbs ◽  
Raphael Wittenberg
Keyword(s):  
Fixed Effects ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Emergency Admission ◽  
Population Data ◽  
Local Area ◽  
Emergency Admissions ◽  
Admission Rates ◽  
Access To Primary Care ◽  
Deprived Areas

Background: Recent studies have found an association between access to primary care and accident and emergency attendances, with better access associated with fewer attendances. Analyses of an association with emergency admissions however have produced conflicting findings. Aim: We investigate whether emergency admission rates in an area are associated with (i) the number of GPs, and (ii) mean size of GP practices. Design and Setting: Analysis was conducted utilising Hospital Episode Statistics, the numbers of GPs and GP practices, ONS population data, Quality and Outcomes Framework (QoF) prevalence data, and Index of Multiple Derivation data, from 2004/5 to 2011/12, for all practices in England. Method: Regression analysis of panel data with fixed effects to address (i) a potential two-way relationship between the numbers of GPs and emergency admissions, and (ii) unobservable characteristics of GP practices. Results: There is not a statistically significant relationship between the number of GPs in a local area and the number of emergency admissions when analysing all areas. However, in deprived areas, a higher number of GPs is associated with lower emergency admissions. There is also a lower emergency admission rate in areas in which practices are on average larger, holding constant GP supply. Conclusions In deprived areas an increase in GPs was found to reduce emergency admissions but does not do so elsewhere. Areas in which GPs became concentrated into larger practices experienced reduced levels of emergency admissions, all else equal.

scholarly journals Cohort study to explore the association between the COVID-19 pandemic lockdown and admissions for violence in North East and North Cumbria

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052923
Author(s):  
Andrea Brown ◽  
Paul Collingwood ◽  
Julia L Newton
Keyword(s):  
Cohort Study ◽  
Lower Layer ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Emergency Admissions ◽  
Admission Rates ◽  
North East ◽  
Accident And Emergency ◽  
Classification Of Diseases ◽  
Icd 10

ObjectivesExplore the association between the first national lockdown associated with the COVID-19 pandemic on admissions for violence and the relationship with deprivation.DesignPopulation-based longitudinal cohort study.SettingNorth East and North Cumbria (NENC) area of England.ParticipantsAll individuals living in the NENC (total population 3.1 million) admitted 2017/2018, 2018/2019, 2019/2020.Main outcome measuresHospital Episode Statistics were extracted at Lower Layer Super Output Area and the Index of Multiple Deprivation 2019 decile applied. Directly standardised rates were explored for number of accident and emergency (A&E) attendances (per 1000); Alcohol-related admissions using Public Health England (PHE) Fingertips tool (per 100 000, ID 91414) and emergency admissions for violence (including sexual violence) (per 100 000) (ID 11201 classified by International Classification of Diseases (ICD)10 codes X85 to Y09).ResultsA&E attendances are higher in NENC compared with England (409.9 per 1000 v 359.2). A&E attendance was 81% higher in 2019/20 in the most deprived compared with the least deprived. Attendances dropped during the first national COVID-19 lockdown and by September 2020 had not returned to ‘normal’ levels.Admissions related to violence are a third higher in NENC (29% to 34% higher across 3 years) rates 7–10 times higher in most deprived than least deprived areas. Admission rates reduced during the first UK lock down but this bounced back by August higher than any of the previous 12 months.ConclusionEmergency admissions with violence appear to associate with the COVID-19 pandemic being initially higher than before the first national lockdown. This is in the context of overall A&E attendances which are lower post lockdown. Given that emergency admissions with violence have been consistently higher in the NENC compared with England over recent years, we suggest that targeted action is required in NENC to address health inequalities.

scholarly journals An Investigation of Variation in Emergency Admission Rates between New Zealand General Practices: a national database linkage study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Hywel Lloyd ◽  
Andrew Tomlin ◽  
Susan Dovey
Keyword(s):  
New Zealand ◽  
Role Models ◽  
Admission Rate ◽  
Emergency Admission ◽  
National Database ◽  
Long Term Conditions ◽  
Emergency Admissions ◽  
Admission Rates ◽  
General Practices

ABSTRACT ObjectiveTo quantify variation in emergency admission rates between all New Zealand general practices and to investigate the influence of patients with long-term conditions. ApproachThis retrospective cohort study linked three national data collection. The Primary Health Organisation (PHO) Enrolment Collection provided practice register data on age sex ethnicity and deprivation. The National Minimum Dataset for Hospital Events (NMDS) allowed access to discharge data. The national Pharmaceutical Collection enabled medicine use to provide a proxy measures of patient morbidity. Expected emergency admission rates for each practice in 2014 were calculated using indirect standardisation with the total registered patient population of all study practices as the reference population. A standardised emergency admission ratio (SAR) of the actual admission rate to the expected admission rate was calculated for each practice. ResultOver the fourteen year period 2001-2014 total emergency admissions from all causes in New Zealand increased by 42%. Arranged and waiting list admissions increased by 29% over the same period. Emergency admissions represented 54% of all admissions by 2014 and increased by 56%. Patients with hospital diagnoses for long-term conditions accounted for 56.5% of all emergency admissions and 78.6% of all associated bed days. More females had unplanned admissions than males (p<0.001, 95% CI 0.48%-0.59%) and more Maori (p<0.001, 95% CI 1.33%-1.49%) and Pacific Island patients (p<0.001, 95% CI 0.96%-1.17%) were admitted than Europeans. Increasing deprivation status was significantly associated with an increased likelihood of admission (p<0.001; chi-squared test for trend). Practices with the highest SARs in 2014 tended to have the highest admission rates in that year and in previous years. They also had high admission rates for both high and low risk patient groups. ConclusionThis study indicates that there is considerable variation in the emergency admission rates of New Zealand general practices and in their standardised emergency admission rates after adjusting for differences in patient demography. A more meaningful measure of true disease morbidity is required to understand more the role ‘models of care’ play in the degree of variation of emergency admission. Keywords: Emergency Admission, practice variation, primary care, New Zealand

scholarly journals Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission

2016 ◽  
Vol 22 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Rachel Meacock ◽  
Laura Anselmi ◽  
Søren Rud Kristensen ◽  
Tim Doran ◽  
Matt Sutton
Keyword(s):  
Primary Care ◽  
Emergency Services ◽  
Hospital Admissions ◽  
Severity Of Illness ◽  
Emergency Admission ◽  
Mortality Rates ◽  
Absolute Number ◽  
Lower Probability ◽  
Emergency Admissions ◽  
Accident And Emergency

Objective Patients admitted as emergencies to hospitals at the weekend have higher death rates than patients admitted on weekdays. This may be because the restricted service availability at weekends leads to selection of patients with greater average severity of illness. We examined volumes and rates of hospital admissions and deaths across the week for patients presenting to emergency services through two routes: (a) hospital Accident and Emergency departments, which are open throughout the week; and (b) services in the community, for which availability is more restricted at weekends. Method Retrospective observational study of all 140 non-specialist acute hospital Trusts in England analyzing 12,670,788 Accident and Emergency attendances and 4,656,586 emergency admissions (940,859 direct admissions from primary care and 3,715,727 admissions through Accident and Emergency) between April 2013 and February 2014.Emergency attendances and admissions to hospital and deaths in any hospital within 30 days of attendance or admission were compared for weekdays and weekends. Results Similar numbers of patients attended Accident and Emergency on weekends and weekdays. There were similar numbers of deaths amongst patients attending Accident and Emergency on weekend days compared with weekdays (378.0 vs. 388.3). Attending Accident and Emergency at the weekend was not associated with a significantly higher probability of death (risk-adjusted OR: 1.010). Proportionately fewer patients who attended Accident and Emergency at weekend were admitted to hospital (27.5% vs. 30.0%) and it is only amongst the subset of patients attending Accident and Emergency who were selected for admission to hospital that the probability of dying was significantly higher at the weekend (risk-adjusted OR: 1.054). The average volume of direct admissions from services in the community was 61% lower on weekend days compared to weekdays (1317 vs. 3404). There were fewer deaths following direct admission on weekend days than weekdays (35.9 vs. 80.8). The mortality rate was significantly higher at weekends amongst direct admissions (risk-adjusted OR: 1.212) due to the proportionately greater reduction in admissions relative to deaths. Conclusions There are fewer deaths following hospital admission at weekends. Higher mortality rates at weekends are found only amongst the subset of patients who are admitted. The reduced availability of primary care services and the higher Accident and Emergency admission threshold at weekends mean fewer and sicker patients are admitted at weekends than during the week. Extending services in hospitals and in the community at weekends may increase the number of emergency admissions and therefore lower mortality, but may not reduce the absolute number of deaths.

scholarly journals Does admission prevalence change after reconfiguration of inpatient services? An interrupted time series analysis of the impact of reconfiguration in five centres

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joanne Martin ◽  
Edwin Amalraj Raja ◽  
Steve Turner
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Emergency Admission ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Emergency Admissions ◽  
Series Analysis ◽  
Inpatient Services ◽  
The Impact ◽  
Admission Prevalence

Abstract Background Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The “natural experiment” of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services? Methods There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one “reconfigured” hospital were halted (permanently or temporarily) and directed to a second “adjacent” hospital. The number of emergency admissions (standardised to /1000 children in the regional population) per month to the “reconfigured” and “adjacent” hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions. Results Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named “adjacent” hospital. Conclusions There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the “adjacent” hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.

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