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Knowles et al in a paper published in EMJ have sought to examine the effect of emergency department (ED) closures on patient outcomes1. This is both welcome and timely, given the current debate on the viability of a number of EDs. Of necessity this is an opportunistic observational study as the ‘intervention’ population are persons within the catchment area of five EDs in England closed in the period 2009 to 2011. The outcome measure was mortality.
As part of the rationale for the paper the authors have suggested that the challenges of rising attendances to, and admissions from, EDs coupled to staff shortages might be mitigated by ‘concentrating resources on fewer sites’. The logic of such a statement is questionable since such ‘concentration’ does nothing to effect any improvement in the overall demand-capacity challenge.
Indeed, with attendances rising by 22% and …
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