The effect on the patient flow in local health care services after closing a suburban primary care emergency department: a controlled longitudinal follow-up study

Mustonen, Katri; Kantonen, Jarmo; Kauppila, Timo

doi:10.1186/s13049-017-0460-3

Cited by 7 publications

(43 citation statements)

References 35 publications

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“…The studies used a variety of observational designs, with before-after and cohort designs being most common. Knowles et al 2 and Mustonen et al 11 were the only studies with independent control sites where no reconfiguration had taken place.…”

Section: Reconfiguration Studiesmentioning

confidence: 99%

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Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Chambers

Cantrell

Baxter

et al. 2020

Health Serv Deliv Res

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Background Service reconfigurations sometimes increase travel time and/or distance for patients to reach their nearest hospital or other urgent and emergency care facility. Many communities value their local services and perceive that proposed changes could worsen outcomes for patients. Objectives To identify, appraise and synthesise existing research evidence regarding the outcomes and impacts of service reconfigurations that increase the time and/or distance for patients to reach an urgent and emergency care facility. We also aimed to examine the available evidence regarding associations between distance to a facility and outcomes for patients and health services, together with factors that may influence (moderate or mediate) these associations. Data sources We searched seven bibliographic databases in February 2019. The search was supplemented by citation-tracking and reference list checking. A separate search was conducted to identify the current systematic reviews of telehealth to support urgent and emergency care. Methods Brief inclusion and exclusion criteria were as follows: (1) population – adults or children with conditions that required emergency treatment; (2) intervention/comparison – studies comparing outcomes before and after a service reconfiguration, which affects the time/distance to urgent and emergency care or comparing outcomes in groups of people travelling different distances to access urgent and emergency care; (3) outcomes – any patient or health system outcome; (4) setting – the UK and other developed countries with relevant health-care systems; and (5) study design – any. The search results were screened against the inclusion criteria by one reviewer, with a 10% sample screened by a second reviewer. A quality (risk-of-bias) assessment was undertaken using The Joanna Briggs Institute Checklist for Quasi-Experimental Studies. We performed a narrative synthesis of the included studies and assessed the overall strength of evidence using a previously published method. Results We included 44 studies in the review, of which eight originated from the UK. For studies of general urgent and emergency care populations, there was no evidence that reconfiguration that resulted in increased travel time/distance affected mortality rates. By contrast, evidence of increased risk was identified from studies restricted to patients with acute myocardial infarction. Increases in mortality risk were most obvious within the first 1–4 years after reconfiguration. Evidence for other conditions was inconsistent or very limited. In the absence of reconfiguration, evidence mainly from cohort studies indicated that increased travel time or distance is associated with increased mortality risk for the acute myocardial infarction and trauma populations, whereas for obstetric emergencies the evidence was inconsistent. We included 12 systematic reviews of telehealth. Meta-analyses suggested that telehealth technologies can reduce time to treatment for people with stroke and ST elevation myocardial infarction. Limitations Most studies came from non-UK settings and many were at high risk of bias because there was no true control group. Most review processes were carried out by a single reviewer within a constrained time frame. Conclusions We found no evidence that increased distance increases mortality risk for the general population of people requiring urgent and emergency care, although this may not be true for people with acute myocardial infarction or trauma. Increases in mortality risk were most likely in the first few years after reconfiguration. Future work Research is needed to better understand how health systems plan for and adapt to increases in travel time, to quantify impacts on health system outcomes, and to address the uncertainty about how risk increases with distance in circumstances relevant to UK settings. Study registration This study is registered as PROSPERO CRD42019123061. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 31. See the NIHR Journals Library website for further project information.

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Section: Reconfiguration Studiesmentioning

confidence: 99%

“…In the reconfiguration group, the most common design was before-after and only four studies compared outcomes between settings with and without changes in distance/time. 2,5,9,11 Association studies generally used a cohort or cross-sectional design (see Table 2).…”

Section: Risk-of-bias Assessmentmentioning

confidence: 99%

Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Chambers

Cantrell

Baxter

et al. 2020

Health Serv Deliv Res

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“…This suggests the possibility that the effect of increased distance or time may be diluted in the general UEC population by the presence of patients with less serious conditions and minimal short-term risk of death. However, one of the largest studies found no change in in-patient mortality for either the population as a whole or subgroups with specific emergency conditions [12]. The implications for the health system as a whole of reconfiguring a key part of UEC might be conjectured as being substantial.…”

Section: Main Findingsmentioning

confidence: 98%

“…The studies used a variety of observational designs, with before-after and cohort designs being most common. Knowles et al [3] and Mustonen et al [12] were the only studies that compared reconfiguration sites with independent control sites where no reconfiguration had taken place.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Effects of service changes affecting distance/time to access urgent and emergency care facilities on patient outcomes: a systematic review

Chambers

Cantrell

Baxter

et al. 2020

BMC Med

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Background: Reconfiguration of urgent and emergency care services often increases travel time/distance for patients to reach an appropriate facility. Evidence of the effects of reconfiguration is important for local communities and commissioners and providers of health services. Methods: We performed a systematic review of the evidence regarding effects of service reconfigurations that increase the time/distance for some patients to reach an urgent and emergency care (UEC) facility. We searched seven bibliographic databases from 2000 to February 2019 and used citation tracking and reference lists to identify additional studies. We included studies of any design that compared outcomes for people with conditions requiring emergency treatment before and after service reconfiguration with an associated change in travel time/distance to access UEC. Studies had to be conducted in the UK or other developed countries. Data extraction and quality assessment (using the Joanna Briggs Institute checklist for quasi-experimental studies) were undertaken by a single reviewer with a sample checked for accuracy and consistency. We performed a narrative synthesis of the included studies. Overall strength of evidence was assessed using a previously published method that considers volume, quality and consistency. Results: We included 12 studies, of which six were conducted in the USA, two in the UK and four in other European countries. The studies used a variety of observational designs, with before-after and cohort designs being most common. Only two studies included an independent control site/sites where no reconfiguration had taken place. The reconfigurations evaluated in these studies reported relatively small effects on average travel times/distance. Discussion: For studies of general UEC populations, there was no convincing evidence as to whether reconfiguration affected mortality risk. However, evidence of increased risk was identified from studies of patients with acute myocardial infarction, particularly 1 to 4 years after reconfiguration. Evidence for other conditions was inconsistent or very limited. Conclusions: We found insufficient evidence to determine whether increased distance to UEC increases mortality risk for the general population of people requiring UEC, although this conclusion may not extend to people with specific conditions.

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The influence of electronic reminders on recording diagnoses in a primary health care emergency department: a register-based study in a Finnish town

Lehto

Pitkälä

Rahkonen

et al. 2021

Scandinavian Journal of Primary Health Care

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Objective: This study examines whether implementation of electronic reminders is associated with a change in the amount and content of diagnostic data recorded in primary health care emergency departments (ED). Design: A register-based 12-year follow-up study with a before-and-after design. Setting: This study was performed in a primary health care ED in Finland. An electronic reminder was installed in the health record system to remind physicians to include the diagnosis code of the visit to the health record. Subjects and main outcome measures: The report generator of the electronic health recordsystem provided monthly figures for the number of different recorded diagnoses by using the International Classification of Diagnoses (ICD-10th edition) and the total number of ED physician visits, thus allowing the calculation of the recording rate of diagnoses on a monthly basis and the comparison of diagnoses before and after implementing electronic reminders. Results: The most commonly recorded diagnoses in the ED were acute upper respiratory infections of various and unspecified sites (5.8%), abdominal and pelvic pain (4.8%), suppurative and unspecified otitis media (4.5%) and dorsalgia (4.0%). The diagnosis recording rate in the ED doubled from 41.2 to 86.3% (p < 0.001) after the application of electronic reminders. The intervention especially enhanced the recording rate of symptomatic diagnoses (ICD-10 group-R) and alcohol abuse-related diagnoses (ICD-10 code F10). Mental and behavioural disorders (group F) and injuries (groups S-Y) were also better recorded after this intervention. Conclusion: Electronic reminders may alter the documentation habits of physicians and recording of clinical data, such as diagnoses, in the EDs. This may be of use when planning resource managing in EDs and planning their actions. KEY POINTSElectronic reminders enhance recording of diagnoses in primary care but what happens in emergency departments (EDs) is not known. Electronic reminders enhance recording of diagnoses in primary care ED. Especially recording of symptomatic diagnoses and alcohol abuse-related diagnoses increased.

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The effect on the patient flow in local health care services after closing a suburban primary care emergency department: a controlled longitudinal follow-up study

Cited by 7 publications

References 35 publications

Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Effects of service changes affecting distance/time to access urgent and emergency care facilities on patient outcomes: a systematic review

The influence of electronic reminders on recording diagnoses in a primary health care emergency department: a register-based study in a Finnish town

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