ArticleInternal and emergency medicine2026
Impact of hospital restructuring on emergency department quality: a natural experiment.
Article in Internal and emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Restructuring hospitals into specialized facilities is an emerging healthcare delivery model; however, evidence regarding the impact on emergency department (ED) quality remains limited. This study assesses the effects of dividing a regional hospital into two specialized hospitals on ED service quality indicators. A retrospective cohort study using difference-in-differences (DID) analysis analyzed 184,127 ED visits from November 2021 to October 2023 at Hsinchu Mackay Memorial Hospital (HMMH). The hospital was divided into specialized hospitals in November 2022. Three Taiwan Healthcare Indicator Series (THIS) metrics were evaluated: Door-to-Physician Time (DTP), Physician-to-Departure Time (PDT), and Decision-to-Departure Time (DDT). Pediatric services (treatment group) were compared with medicine, surgery, and other specialties (control group). Total ED visits increased by 8.3% after the conversion. Pediatric visits rose significantly by 74.3% (from 22,510 to 39,226), while visits for medicine decreased by 26.4%. Overall efficiency improved in control specialties: Door-to-Physician Time decreased by 8.97%, Physician-to-Departure Time by 17.92%, and Decision-to-Departure Time by 24.56% (all p < 0.001). However, pediatric services showed different effects, with increases in Door-to-Physician Time (+ 18.7 min), Physician-to-Departure Time (+ 14.6 min), and Decision-to-Departure Time (+ 4.9 min) compared to control specialties (all p < 0.001). Despite these longer times, pediatric indicators stayed within clinically acceptable ranges. Hospital specialization had mixed effects, boosting efficiency for general services but increasing capacity pressures in pediatric emergency care. The sharp rise in pediatric cases confirms the appeal of specialty hospitals but calls for adaptive resource-allocation strategies. These findings guide policy decisions on developing specialty hospitals and organizing emergency services.
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