An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015

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dc.contributor.author Lynch, Brenda
dc.contributor.author Browne, John P.
dc.contributor.author Buckley, Claire Mary
dc.contributor.author Healy, Orla
dc.contributor.author Corcoran, Paul
dc.contributor.author Fitzgerald, Anthony P.
dc.date.accessioned 2019-10-23T03:45:56Z
dc.date.available 2019-10-23T03:45:56Z
dc.date.issued 2019-09-17
dc.identifier.citation Lynch, B., Browne, J., Buckley, C. M., Healy, O., Corcoran, P. and Fitzgerald, A. P. (2019) 'An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015', BMJ Open, 9(9), e029261. (13pp.) DOI: 10.1136/bmjopen-2019-029261 en
dc.identifier.volume 9 en
dc.identifier.issued 9 en
dc.identifier.startpage 1 en
dc.identifier.endpage 13 en
dc.identifier.issn 0017-9124
dc.identifier.uri http://hdl.handle.net/10468/8813
dc.identifier.doi 10.1136/bmjopen-2019-029261 en
dc.description.abstract Objectives: To understand the impact of emergency department (ED) reconfiguration on the number of patients waiting for hospital beds on trolleys in the remaining EDs in four geographical regions in Ireland using time-series analysis. Setting: EDs in four Irish regions; the West, North-East, South and Mid-West from 2005 to 2015. Participants: All patients counted as waiting on trolleys in an ED for a hospital bed in the study hospitals from 2005 to 2015. Intervention: The system intervention was the reconfiguration of ED services, as determined by the Department of Health and Health Service Executive. The timing of these interventions varied depending on the hospital and region in question. Results: Three of the four regions studied experienced a significant change in ED trolley numbers in the 12-month post-ED reconfiguration. The trend ratio before and after the intervention for these regions was as follows: North-East incidence rate ratio (IRR) 2.85 (95% CI 2.04 to 3.99, p<0.001), South IRR 0.68 (95% CI 0.51 to 0.89, p=0.006) and the Mid-West IRR 0.03 (95% 1.03 to 2.03, p=0.03). Two of these regions, the South and the Mid-West, displayed a convergence between the observed and expected trolley numbers in the 12-month post-reconfiguration. The North-East showed a much steeper increase, one that extended beyond the 12-month period post-ED reconfiguration. Conclusions: Findings suggest that the impacts of ED reconfiguration on regional level ED trolley trends were either non-significant or caused a short-term shock which converged on the pre-reconfiguration trend over the following 12 months. However, the North-East is identified as an exception due to increased pressures in one regional hospital, which caused a change in trend beyond the 12-month post reconfiguration. en
dc.description.sponsorship Health Research Board ('Funding University College Cork Collaborative Applied Research Grant 2012' CARG/2012/28) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BMJ Open en
dc.relation.uri https://bmjopen.bmj.com/content/9/9/e029261
dc.rights © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. en
dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/ en
dc.subject Time-series en
dc.subject Emergency department reconfiguration en
dc.subject Regional emergency department en
dc.subject Trolley numbers en
dc.subject Ireland en
dc.title An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015 en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Brenda Lynch, School of Public Health, University College Cork, Cork, Ireland. +353-21-490-3000 Email:brendalynch@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder Health Research Board en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Health Services Research en
dc.internal.IRISemailaddress brendalynch@ucc.ie en
dc.internal.IRISemailaddress j.browne@ucc.ie en
dc.identifier.articleid e029261 en
dc.identifier.eissn 1475-6773


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© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. Except where otherwise noted, this item's license is described as © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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