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Downgrading A&E units does not increase deaths – study

But downgrading or closing units may put pressure on local ambulance services, researchers found

Downgrading emergency departments does not lead to a spike in deaths – despite patients having to travel further for emergency care, a new study suggests.

But downgrading or closing units may heap pressure on local ambulance services, the researchers found.

The closure of emergency departments are hot political topics, sparking much debate among local communities – but there has been little research into the actual impact of closing the doors of an A&E unit.

Units can be downgraded – for instance changing from a 24-hour consultant-led unit to a minor injuries or urgent care unit – or closed as services are disrupted by issues such as staffing problems or are reorganised.

Researchers from the University of Sheffield set out to examine the impact of five emergency departments in England that were downgraded between 2009 and 2011.

The study – which evaluated units in Newark, Rochdale, Hartlepool, Bishop Auckland and Hemel Hempstead both before and after the emergency departments were downgraded – found no overall increase in the number of deaths.

“This suggests that any negative effects caused by increased journey time to the ED [emergency department] can be offset by other factors; for example, if other new services are introduced and care becomes more effective than it used to be, or if the care received at the now-nearest hospital is more effective than that provided at the hospital where the ED closed,” the authors wrote.

However, they said that there were implications on other NHS emergency care providers, such as an influx in the volume of calls to ambulance services.

They noted an increase in the number of incidents that were dealt with by the ambulance service and an increase in the time taken to get to hospital, according to the study, published by the National Institute for Health Research.

The authors pointed out that in four of the five areas studied, the emergency department was replaced with an on site urgent care facility.

Emma Knowles, from the School of Health and Related Research at the University of Sheffield, said: “The public, in particular, require reassurance that the closure or downgrade of an ED does not result in increased death rates.”

The study’s co-author, Professor Jon Nicholl, added: “It is important to highlight that we didn’t find the better outcomes for patients that planners hoped to see from closing these small departments either.

“This means it isn’t clear that the disruption and anxiety that can be caused by closing emergency departments is worthwhile.”

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