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

Lynch, Brenda; Browne, John P.; Buckley, Claire Mary; Healy, Orla; Corcoran, Paul; Fitzgerald, Anthony P.

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

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.contributor.funder	Health Research Board	en
dc.date.accessioned	2019-10-23T03:45:56Z
dc.date.available	2019-10-23T03:45:56Z
dc.date.issued	2019-09-17
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.description.status	Peer reviewed	en
dc.description.version	Published Version	en
dc.format.mimetype	application/pdf	en
dc.identifier.articleid	e029261	en
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.doi	10.1136/bmjopen-2019-029261	en
dc.identifier.eissn	1475-6773
dc.identifier.endpage	13	en
dc.identifier.issn	0017-9124
dc.identifier.issued	9	en
dc.identifier.journaltitle	Health Services Research	en
dc.identifier.startpage	1	en
dc.identifier.uri	https://hdl.handle.net/10468/8813
dc.identifier.volume	9	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