Improving emergency attendance and mortality--the case for unit separation

Emergency attendance and mortality which are reliable indicators of quality of care, have been of concern to many health institutions. Different models are being proposed to improve emergency outcomes in different parts of the world. A model to separate a single emergency unit into multiple emergency units has been tried in Ghana.

The objective of the study was to find the effect of the Unit Separation Model (USM) on the quality of emergency care delivery in a developing country.

The study compared the outcomes (attendance and mortality) in a Single Emergency Model (SEM) with a USM, over a two-year period. Two groups of patients were studied--the SEM phase comprising 809 patients, and the USM phase comprising 3,505 patients. Data on patients' attendance and mortality in the two groups were analysed.

Attendance increased four fold in the USM period compared to the SEM period. This also reflected in increases in individual unit attendance. There was almost a three fold increase in medical and surgical emergencies, over ten fold increase in gynaecological emergencies and over twenty fold increase in paediatric emergencies. There was a statistically significant reduction in emergency mortality in the USM period compared to the SEM period. Reductions in mortality were from 27.8% to 7.9% for Surgery, 46.3% to 23.2% for Medicine, 17.5% to 0.8% for Gynaecology, and 50.0% to 8.4% for Paediatrics (p-value < 0.001 for each unit); and overall from 36.7% to 10.9%.

It is concluded that Unit Separation Model with Specialty based emergency care has a positive impact of increasing emergency admissions and reducing mortality, without compromising quality. This also means that avoidable mortalities occur in the Single Emergency Model system.