ArticleEmergency medicine journal : EMJ2001
The Sheffield experiment: the effects of centralising accident and emergency services in a large urban setting.
Article in Emergency medicine journal : EMJ, 2001. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Economic evaluations on centralisation of specialised healthcare services: a systematic review of methods.BMJ open · 2016Pooled it
- Guiding interoperable electronic health records through patient-sharing networks.NPJ digital medicine · 2018Article
- Things that go beep: experience with an ED guideline for use of a handheld metal detector in the management of ingested non-hazardous metallic foreign bodies.Emergency medicine journal : EMJ · 2006Article
- Targets and moving goal posts: changes in waiting times in a UK emergency department.Emergency medicine journal : EMJ · 2005Article
- Does the use of a specialised paediatric retrieval service result in the loss of vital stabilisation skills among referring hospital staff?Archives of disease in childhood · 2003Article
- Emergency nurse practitioners: a three part study in clinical and cost effectiveness.Emergency medicine journal : EMJ · 2003Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess the effects of centralisation of accident and emergency (A&E) services in a large urban setting. The end points were the quality of patient care judged by time to see a doctor or nurse practitioner, time to admission and the cost of the A&E service as a whole.
methodsSheffield is a large industrial city with a population of 471000. In 1994 Sheffield health authority took a decision to centralise a number of services including the A&E services. This study presents data collected over a three year period before, during and after the centralisation of adult A&E services from two sites to one site and the centralisation of children's A&E services to a separate site. A minor injury unit was also established along with an emergency admissions unit. The study used information from the A&E departments' computer system and routinely available financial data.
resultsThere has been a small decrease in the number of new patient attendances using the Sheffield A&E system. Most patients go to the correct department. The numbers of acute admissions through the adult A&E have doubled. Measures of process efficiency show some improvement in times to admission. There has been measurable deterioration in the time to be seen for minor injuries in the A&E departments. This is partly offset by the very good waiting time to be seen in the minor injuries unit. The costs of providing the service within Sheffield have increased.
conclusionCentralisation of A&E services in Sheffield has led to concentration of the most ill patients in a single adult department and separate paediatric A&E department. Despite a greatly increased number of admissions at the adult site this change has not resulted in increased waiting times for admission because of the transfer of adequate beds to support the changes. There has however been a deterioration in the time to see a clinician, especially in the A&E departments. The waiting times at the minor injury unit are very short.
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