TY - JOUR T1 - Process and Systems: A cohort study to evaluate the impact of service centralisation for emergency admissions with acute heart failure JF - Future Healthcare Journal JO - Future Healthc J SP - 41 LP - 46 DO - 10.7861/futurehosp.6-1-41 VL - 6 IS - 1 AU - Chris Wilkinson AU - Honey Thomas AU - Peter McMeekin AU - Chris Price Y1 - 2019/02/01 UR - http://www.rcpjournals.org/content/6/1/41.abstract N2 - The aim of our study was to describe the impact of emergency care centralisation on unscheduled admissions with a primary discharge diagnosis of acute heart failure (HF). We carried out a retrospective cohort study of HF admissions 1 year before and 1 year after centralisation of three accident and emergency departments into one within a single large NHS trust. Outcomes included mortality, length of stay, readmissions, specialist inpatient input and follow-up, and prescription rates of stabilising medication. Baseline characteristics were similar for 211 patients before and for 307 following reconfiguration. Median length of stay decreased from 8 to 6 days (p=0.020) without an increase in readmissions (4.7% versus 4.2%, p=0.813). The proportion with specialist follow-up increased (60% to 72%, p=0.036). There was a trend towards decreased mortality (32.2% versus 27.7% at 90 days; p=0.266). Contact with the cardiology team was associated with decreased mortality. In conclusion, centralisation of specialist emergency care was associated with greater service efficiency and a trend towards reduced mortality. ER -