Acute hospital reconfiguration and self-harm presentations: a before-and-after study
The evidence for improved patient outcomes following acute hospital reconfiguration is limited.
We assessed the impact of the reconfiguration of acute services within a hospital group in terms of the number and clinical management of self-harm presentations.
The study was conducted across the three Mid-Western regional hospitals in Ireland during 2004–2014. Reconfiguration in April 2009 involved two hospitals reducing the operation of their emergency departments (EDs) from 24 to 12 h. We used Poisson regression analysis of data from the National Self-Harm Registry Ireland to assess change in the hospital burden and clinical management of self-harm associated with the reconfiguration.
We observed that the cumulative decrease in self-harm presentations at the two reconfigured hospitals was of a similar magnitude to the increase observed at the larger hospital. Despite this large increase in presentations, there was only a small increase in admissions. Reconfiguration of hospital services was also associated with changes in the provision of assessments for self-harm patients.
There is evidence to suggest that acute hospital reconfiguration of hospital services impacts on patterns of patient flow. Findings have implications for those implementing reconfiguration of acute services.
KeywordsAcute health services Hospital reconfiguration Self-harm
The National Self-Harm Registry Ireland is funded by the Irish Health Service Executive’s National Office for Suicide Prevention.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The National Research Ethics Committee of the Faculty of Public Health Medicine, Dublin granted ethical approval for the National Self-Harm Registry Ireland. The Registry has also received ethical approval from the relevant hospitals and Health Service Executive (HSE) ethics committees. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
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