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The impact of closing emergency departments on mortality in emergencies: an observational study
  1. Emma Knowles,
  2. Neil Shephard,
  3. Tony Stone,
  4. Suzanne M Mason,
  5. Jon Nicholl
  1. School of Health and Related Research, University of Sheffield, Sheffield, UK
  1. Correspondence to Emma Knowles, University of Sheffield, Sheffield S1 4DA, UK; e.l.knowles{at}


Background In England the demand for emergency care is increasing, while there is also a staffing shortage. This has implications for quality of care and patient safety. One solution may be to concentrate resources on fewer sites by closing or downgrading emergency departments (EDs). Our aim was to quantify the impact of such reorganisation on population mortality.

Methods We undertook a controlled interrupted time series analysis to detect the impact of closing or downgrading five EDs, which occurred due to concerns regarding sustainability. We obtained mortality data from 2007 to 2014 using national databases. To establish ED resident catchment populations, estimated journey times by road were supplied by the Department for Transport. Other major changes in the emergency and urgent care system were determined by analysis of annual NHS Trust reports in each geographical area studied. Our main outcome measures were mortality and case fatality for a set of 16 serious emergency conditions.

Results For residents in the areas affected by closure, journey time to the nearest ED increased (median change 9 min, range 0–25 min). We found no statistically reliable evidence of a change in overall mortality following reorganisation of ED care in any of the five areas or overall (+2.5% more deaths per month on average; 95% CI −5.2% to +10.2%; p=0.52). There was some evidence to suggest that, on average across the five areas, there was a small increase in case fatality, an indicator of the ‘risk of death’ (+2.3%, 95% CI +0.9% to+3.6%; p<0.001), but this may have arisen due to changes in hospital admissions.

Conclusions We found no evidence that reorganisation of emergency care was associated with a change in population mortality in the five areas studied. Further research should establish the economic consequences and impact on patient experience and neighbouring hospitals.

  • death/mortality
  • emergency care systems
  • emergency departments

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  • EK and JN contributed equally.

  • Contributors JN conceived the idea for the study, and along with EK, contributed to the design of the study. JN led the analysis of the data, and was assisted by TS and NS. JN wrote the first draft of the paper. All authors contributed to further drafts and approved the final manuscript.

  • Funding This work was supported by the National Institute of Health Research (Health Services and Delivery Research Programme) grant number 13/10/42.

  • Competing interests JN has previously written an article for a newspaper (Mail on Sunday) on the same topic. No payment was made for this article. SM is a member of the HS&DR Commissioning Board.

  • Patient consent for publication Not required.

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

  • Data availability statement No data are available.

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