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Three into one does go?
  1. Clifford Mann
  1. Emergency Department, Taunton and Somerset NHS Foundation Trust, Taunton, UK
  1. Correspondence to Dr Clifford Mann, Emergency Department, Taunton and Somerset NHS Foundation Trust, Taunton TA1 5DA, UK; clifford.mann{at}nhs.net

https://doi.org/10.1136/emermed-2019-209248

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    The EMJ paper by Price et al 1 adds to the literature assessing the impact of system reconfigurations and specifically the impact on ED patients.

    A related paper looking at the impact of ED closures, journey times and mortality was published in November.2 3 The Price paper considers the mortality consequences of centralising ED care.

    The authors explain that ‘national policy favours centralisation of emergency medical care’ driven by evidence of ‘improved outcomes and efficiency for specific conditions’. Such improvements have undoubtedly been seen in ST elevation myocardial infarction (STEMI),4 Major Trauma5 and Stroke6 (the stroke, trauma and STEMI (STS) group), but importantly, such patients represent less than 5% of ED attendances.

    Based upon this linkage of system redesign and improved outcomes, the paper poses the hypothesis that centralisation might also reduce mortality for the much larger remainder cohort of undifferentiated and unselected emergency presentations.

    The researchers have taken the opportunity to study this possibility by examining the mortality consequences observed following the replacement of three District General Hospital (DGH) EDs with a single large specialist emergency centre.

    The ‘control group’ are the patients who attended the three DGH EDs at North Tyneside, Wansbeck and Hexham hospitals between June 2014 and June 2015. The ‘intervention’ group are the patients who attended the new single-site Northumbria …

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    Footnotes

    • Twitter @DrCJM

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

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