Spotlight on Research

Pressure on the UK emergency care systems continues unabated as demands on the ambulance service and emergency departments (EDs) increase year on year. Despite this, a small number of EDs have been closed, downgraded to a less acute facility, or had night-time closures enforced, reportedly owing to inadequate staffing and safety implications. The decisions were made with little research evidence to inform the decision making, so concerns about patient safety are reasonable. A recently published study sought to quantify the impact on mortality of ED closures on the resident catchment populations of five EDs compared with five control areas.

For residents in the areas affected by closure, journey time to the nearest ED increased by a median of 9 minutes (range 0–25 minutes) but there was no statistically reliable evidence of a change in overall mortality. The findings suggest that, on average across the five areas, there was a small increase in case fatality—an indicator of the ‘risk of death’ (+2.3%, 95% CI +0.9% to+3.6%; p<0.001), but argue that this may have arisen due to changes in hospital admissions. The findings may be reassuring from a mortality perspective, but the impact of closing an ED has far wider implications than mortality alone.