Impact of Emergency Department Closures and Centralization of Acute Surgical Services on Patient Mortality

Background: Despite nation-wide efforts to reduce health care costs through emergency department closures and centralization of services (COS), little is known about the impact of such actions on mortality of surgical patients (MOSP). Aim: To determine the impact on MOSP as a result of a recent centralization of acute surgical services to Mid Western Regional University Hospital Limerick (MWRUHL). Methods: Hospital Inpatient Enquiry data was used to identify patients who had mortalities at MWRUHL during the years 2007, 2008, 2011 and 2012. This represented 24 months pre and post centralization of acute surgical services to MWRUHL. Data was excluded from the years 2009 and 2010 to minimize bias arising during the transitional period. Results: The total number of surgical mortalities pre-centralization was 116 with 55 and 66 respectively for years 2007 and 2008. Total occupied inpatient mortality bed days were 13676 with an avg. of 117.90 per mortality. Average age per surgical patient mortality was 72.76 years with SD 14.29. Similarly, the total number of surgical mortalities post-centralization was also 116 with 61 and 55 respectively for years 2011 and 2012. Total occupied inpatient mortality bed days were 18830 with an avg. of 162.33 per mortality. Average age for this group was 72.25 years with SD 13.73. Conclusion: COS to MWRUHL was not associated with a resultant increase in inpatient surgical mortality. Our findings indicate that controversial changes to the structure of the health care system can occur without losses in patient safety and reduction in quality of care.